Provider Demographics
NPI:1790100535
Name:HEAVEN CARE NURSING AGENCY
Entity Type:Organization
Organization Name:HEAVEN CARE NURSING AGENCY
Other - Org Name:HEAVEN CARE NURSING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIREILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-356-4724
Mailing Address - Street 1:20295 NW 2ND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2550
Mailing Address - Country:US
Mailing Address - Phone:754-400-0887
Mailing Address - Fax:
Practice Address - Street 1:20295 NW 2ND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2550
Practice Address - Country:US
Practice Address - Phone:754-400-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAVEN CARE NURSING AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health