Healthcare Provider Details

I. General information

NPI: 1659979425
Provider Name (Legal Business Name): HEAVENLY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 EVENINGWIND DR
MARION AR
72364-3017
US

IV. Provider business mailing address

117 EVENINGWIND DR
MARION AR
72364-3017
US

V. Phone/Fax

Practice location:
  • Phone: 901-326-4851
  • Fax:
Mailing address:
  • Phone: 901-326-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MRS. GABRIELLE GUY
Title or Position: OWNER
Credential: RN
Phone: 901-326-4851