MEDICARE: HEAVENLY ANGEL HEALTHCARE 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	261QA0600X	Adult Day Care Clinic/Center
2	251E00000X	Home Health Agency		VA

General Provider Information

NPI Number	:	1982112272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY ANGEL HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1530 LAKE SPEIGHT DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 LAKE SPEIGHT DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6029
Country	:	US
Telephone Number	:	757-934-8258
Fax Number	:

Authorized Official
Title or Position	:	ABMINISTRATOR
Name	:	JOANNE CALVIE
Credential	:
Telephone Number	:	757-934-8258

Provider Enumeration Date	:	01/20/2018
Last Update Date	:	04/18/2023

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