Provider Demographics
NPI:1649963943
Name:HEAVEN ON EARTH HOME HEALTHCARE
Entity type:Organization
Organization Name:HEAVEN ON EARTH HOME HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANEKA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-410-8454
Mailing Address - Street 1:1749 WOOD CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-5016
Mailing Address - Country:US
Mailing Address - Phone:443-410-8454
Mailing Address - Fax:
Practice Address - Street 1:1749 WOOD CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-5016
Practice Address - Country:US
Practice Address - Phone:443-410-8454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty