Healthcare Provider Details

I. General information

NPI: 1699193052
Provider Name (Legal Business Name): HEAVENLY HOSPICE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 COMMERCE AVE STE G
PALMDALE CA
93551-3799
US

IV. Provider business mailing address

514 COMMERCE AVE STE G
PALMDALE CA
93551-3799
US

V. Phone/Fax

Practice location:
  • Phone: 818-666-4015
  • Fax: 661-206-8415
Mailing address:
  • Phone: 818-666-4015
  • Fax: 661-206-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MARLENE GONZALEZ
Title or Position: CEO/DPCS
Credential: RN
Phone: 818-666-4015