Provider Demographics
NPI:1396480604
Name:HEAVEN'S HALO
Entity type:Organization
Organization Name:HEAVEN'S HALO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:FERN
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-510-0591
Mailing Address - Street 1:101 MANOR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-3211
Mailing Address - Country:US
Mailing Address - Phone:502-348-0439
Mailing Address - Fax:
Practice Address - Street 1:101 MANOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-3211
Practice Address - Country:US
Practice Address - Phone:502-348-0439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health