Provider Demographics
NPI:1669700134
Name:HEAVENLY GOLDEN YEARS SERVICES, INC
Entity type:Organization
Organization Name:HEAVENLY GOLDEN YEARS SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:V
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-536-0590
Mailing Address - Street 1:5460 HOFFNER AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2511
Mailing Address - Country:US
Mailing Address - Phone:407-536-0590
Mailing Address - Fax:407-249-9207
Practice Address - Street 1:5460 HOFFNER AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2511
Practice Address - Country:US
Practice Address - Phone:407-536-0590
Practice Address - Fax:407-249-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-22
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health