Provider Demographics
NPI:1679205819
Name:ANDRE HEAVENLY HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:ANDRE HEAVENLY HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-856-5317
Mailing Address - Street 1:20200 GOVERNORS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1032
Mailing Address - Country:US
Mailing Address - Phone:708-856-5317
Mailing Address - Fax:708-312-5399
Practice Address - Street 1:20200 GOVERNORS DR FL 3
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1032
Practice Address - Country:US
Practice Address - Phone:708-856-5317
Practice Address - Fax:708-312-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health