MEDICARE: HEAVENLY HEALING HOMECARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1639911431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HEALING HOMECARE LLC

Provider Business Mailing Address
First Line	:	7850 BULLFINCH LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7955
Country	:	US
Telephone Number	:	267-499-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 BULLFINCH LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7955
Country	:	US
Telephone Number	:	267-499-0182
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE/OWNER
Name	:	JUILLET MCKAY KOFA
Credential	:
Telephone Number	:	267-499-0182

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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