Provider Demographics
NPI:1831886340
Name:HEAVEN CARE RESIDENTIAL LLC
Entity type:Organization
Organization Name:HEAVEN CARE RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-999-0293
Mailing Address - Street 1:1707 E CITATION LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1606
Mailing Address - Country:US
Mailing Address - Phone:480-999-0293
Mailing Address - Fax:833-286-8210
Practice Address - Street 1:1707 E CITATION LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1606
Practice Address - Country:US
Practice Address - Phone:480-999-0293
Practice Address - Fax:833-286-8210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAVEN CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty