Provider Demographics
NPI:1700115912
Name:HEAVENLY WORKS HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:HEAVENLY WORKS HOME HEALTH CARE SERVICES
Other - Org Name:HEAVENLY WORKS HOME HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:RENNE
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:99 CREDITS
Authorized Official - Phone:757-717-1785
Mailing Address - Street 1:5040 VIRGINIA BEACH BLVD
Mailing Address - Street 2:103
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6637
Mailing Address - Country:US
Mailing Address - Phone:757-718-7355
Mailing Address - Fax:757-961-8744
Practice Address - Street 1:5040 VIRGINIA BEACH BLVD
Practice Address - Street 2:103
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23462-6637
Practice Address - Country:US
Practice Address - Phone:757-718-7355
Practice Address - Fax:757-961-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA128291251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health