Provider Demographics
NPI: | 1922694413 |
---|---|
Name: | HEAVENIA'S HUMBLE HEART RCF, LLC |
Entity Type: | Organization |
Organization Name: | HEAVENIA'S HUMBLE HEART RCF, LLC |
Other - Org Name: | HEAVENIA'S HUMBLE HEART RCF, LLC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALELISHA |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | PIPKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 216-673-8725 |
Mailing Address - Street 1: | 4640 E 93RD ST |
Mailing Address - Street 2: | |
Mailing Address - City: | GARFIELD HTS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44125-1342 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 216-673-8725 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4640 E 93RD ST |
Practice Address - Street 2: | |
Practice Address - City: | GARFIELD HTS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44125-1342 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-673-8725 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-12-18 |
Last Update Date: | 2023-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 251E00000X | Agencies | Home Health | |
No | 251S00000X | Agencies | Community/Behavioral Health | |
No | 253Z00000X | Agencies | In Home Supportive Care | |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
No | 310500000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | |
No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | |
No | 347C00000X | Transportation Services | Private Vehicle | |
No | 385H00000X | Respite Care Facility | Respite Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 1720672298 | Medicaid |