Provider Demographics
NPI:1679875710
Name:HEAVENLY ANGELS HOME CARE
Entity Type:Organization
Organization Name:HEAVENLY ANGELS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DE LOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-444-7094
Mailing Address - Street 1:4709 MOUNT ABERNATHY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3340
Mailing Address - Country:US
Mailing Address - Phone:858-444-7904
Mailing Address - Fax:858-278-2093
Practice Address - Street 1:4709 MOUNT ABERNATHY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3340
Practice Address - Country:US
Practice Address - Phone:858-444-7904
Practice Address - Fax:858-278-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB2010022157251B00000X, 251E00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care