Provider Demographics
NPI:1104158419
Name:HEAVEN HOSPICE, INC.
Entity type:Organization
Organization Name:HEAVEN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBANENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-508-4210
Mailing Address - Street 1:14557 FRIAR ST STE B1
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2312
Mailing Address - Country:US
Mailing Address - Phone:818-508-4210
Mailing Address - Fax:818-508-4652
Practice Address - Street 1:14557 FRIAR ST STE B1
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2312
Practice Address - Country:US
Practice Address - Phone:818-508-4210
Practice Address - Fax:818-508-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based