Provider Demographics
NPI:1649541798
Name:HEAVENLY CARE
Entity type:Organization
Organization Name:HEAVENLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:P
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-610-4557
Mailing Address - Street 1:PO BOX 44331
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-7331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:414-434-1981
Practice Address - Street 1:1016 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1327
Practice Address - Country:US
Practice Address - Phone:414-610-4557
Practice Address - Fax:414-434-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health