Provider Demographics
NPI:1912235912
Name:HEAVENLY CARE, LLC
Entity Type:Organization
Organization Name:HEAVENLY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZANNOU
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:402-290-9623
Mailing Address - Street 1:2507 S 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2065
Mailing Address - Country:US
Mailing Address - Phone:402-614-9574
Mailing Address - Fax:402-218-1644
Practice Address - Street 1:2507 S 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2065
Practice Address - Country:US
Practice Address - Phone:402-614-9574
Practice Address - Fax:402-218-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care