Provider Demographics
NPI:1720330772
Name:D&D HEAVENLY HEALTHCARE INC
Entity Type:Organization
Organization Name:D&D HEAVENLY HEALTHCARE INC
Other - Org Name:D&D HEAVENLY HEALTHCARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-766-7532
Mailing Address - Street 1:19 RUSTIC BEND PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-3803
Mailing Address - Country:US
Mailing Address - Phone:832-766-7532
Mailing Address - Fax:281-789-7475
Practice Address - Street 1:19 RUSTIC BEND PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-3803
Practice Address - Country:US
Practice Address - Phone:832-766-7532
Practice Address - Fax:281-789-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013626251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2179582Medicaid