Provider Demographics
NPI:1952794174
Name:HEAVENLY HANDS SERVICES LLC
Entity type:Organization
Organization Name:HEAVENLY HANDS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-793-7007
Mailing Address - Street 1:1414 NORTH RONALD REAGAN BLVD.
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750
Mailing Address - Country:US
Mailing Address - Phone:407-793-7007
Mailing Address - Fax:407-205-1188
Practice Address - Street 1:1414 NORTH RONALD REAGAN BLVD.
Practice Address - Street 2:SUITE 1220
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750
Practice Address - Country:US
Practice Address - Phone:407-793-7007
Practice Address - Fax:407-205-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012176500Medicaid
FL30212394Medicaid
FL012176501OtherHOMEMAKER AND COMPANION
FL012176501Medicaid