Provider Demographics
NPI: | 1811566441 |
---|---|
Name: | HEAVENLY WORKS LLC |
Entity Type: | Organization |
Organization Name: | HEAVENLY WORKS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PRESIDENT/ALT ADMIN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HAROLD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WASHINGTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 909-682-5850 |
Mailing Address - Street 1: | 3836 BLACK OAK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | DALLAS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75241-3309 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-682-5850 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3836 BLACK OAK DR |
Practice Address - Street 2: | |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75241-3309 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-682-5850 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-06-18 |
Last Update Date: | 2021-06-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care | Group - Multi-Specialty | |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Multi-Specialty |