Provider Demographics
NPI:1881315562
Name:HEAVENLY CARE LLC
Entity type:Organization
Organization Name:HEAVENLY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-500-6121
Mailing Address - Street 1:67 BUCK RD STE B53
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1540
Mailing Address - Country:US
Mailing Address - Phone:215-500-6121
Mailing Address - Fax:
Practice Address - Street 1:385 KINGS HWY N STE 207
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1013
Practice Address - Country:US
Practice Address - Phone:215-500-6121
Practice Address - Fax:445-300-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care