Provider Demographics
NPI:1801500863
Name:HEAVENLY HOLDEN HOMECARE AGENCY LLC
Entity type:Organization
Organization Name:HEAVENLY HOLDEN HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CIERRIA ESTAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-704-8325
Mailing Address - Street 1:8987 US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-0826
Mailing Address - Country:US
Mailing Address - Phone:832-797-9028
Mailing Address - Fax:
Practice Address - Street 1:8987 US HIGHWAY 259
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-0826
Practice Address - Country:US
Practice Address - Phone:832-797-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty