MEDICARE: HEAVENLY CARE FACILITY

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

General Provider Information

NPI Number	:	1558489872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY CARE FACILITY

Provider Business Mailing Address
First Line	:	4540 FLORIN RD
Second Line	:	SUITE 373
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2536
Country	:	US
Telephone Number	:	916-826-5817
Fax Number	:	916-424-7520

Provider Business Practice Location Address
First Line	:	4420 C PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-3010
Country	:	US
Telephone Number	:	916-826-5817
Fax Number	:	916-424-7520

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MRS. KEASHA T WALTON ELLIS
Credential	:
Telephone Number	:	916-275-4567

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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Directions to “HEAVENLY CARE FACILITY ” Practice Location

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