Provider Demographics
NPI:1457134744
Name:METTA HEAVEN HOME CARE LLC
Entity Type:Organization
Organization Name:METTA HEAVEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WATSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-417-4545
Mailing Address - Street 1:11015 SW 243RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5149
Mailing Address - Country:US
Mailing Address - Phone:954-417-4545
Mailing Address - Fax:
Practice Address - Street 1:14707 S DIXIE HWY STE 402C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7954
Practice Address - Country:US
Practice Address - Phone:877-307-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health