Provider Demographics
NPI:1023324480
Name:HEAVEN SENT HOMECARE SENIOR SERVICES
Entity type:Organization
Organization Name:HEAVEN SENT HOMECARE SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CARLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-785-4040
Mailing Address - Street 1:71 RANDOLPH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164
Mailing Address - Country:US
Mailing Address - Phone:386-785-4040
Mailing Address - Fax:386-313-6190
Practice Address - Street 1:71 RANDOLPH DRIVE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-785-4040
Practice Address - Fax:386-313-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231817251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health