Healthcare Provider Details

I. General information

NPI: 1194297838
Provider Name (Legal Business Name): HEAVEN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S STANDAGE
MESA AZ
85202-8139
US

IV. Provider business mailing address

3116 S MILL AVE STE 176
TEMPE AZ
85282-3675
US

V. Phone/Fax

Practice location:
  • Phone: 480-580-4062
  • Fax: 480-839-4273
Mailing address:
  • Phone: 480-580-4062
  • Fax: 480-839-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: WESLEY YOUNG
Title or Position: OWNER
Credential:
Phone: 480-580-4062