Provider Demographics
NPI:1639911431
Name:HEAVENLY HEALING HOMECARE LLC
Entity type:Organization
Organization Name:HEAVENLY HEALING HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUILLET
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:KOFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-499-0182
Mailing Address - Street 1:7850 BULLFINCH LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7955
Mailing Address - Country:US
Mailing Address - Phone:267-499-0182
Mailing Address - Fax:
Practice Address - Street 1:7850 BULLFINCH LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-7955
Practice Address - Country:US
Practice Address - Phone:267-499-0182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care