MEDICARE: HEAVENLY HANDS COMPANION SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518614387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HANDS COMPANION SERVICES LLC

Provider Business Mailing Address
First Line	:	6314 NW HERMES CT
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-3881
Country	:	US
Telephone Number	:	561-598-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	6314 NW HERMES CT
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-3881
Country	:	US
Telephone Number	:	561-598-1710
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERIKA AYERS
Credential	:
Telephone Number	:	561-598-1710

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/03/2022

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