Healthcare Provider Details

I. General information

NPI: 1295659126
Provider Name (Legal Business Name): HEAVENLY HANDS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 ELKRIDGE ST
DAVENPORT FL
33837-8511
US

IV. Provider business mailing address

1915 ELKRIDGE ST
DAVENPORT FL
33837-8511
US

V. Phone/Fax

Practice location:
  • Phone: 863-391-8379
  • Fax:
Mailing address:
  • Phone: 863-391-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DIANDRA WRIGHT
Title or Position: SECRETARY
Credential:
Phone: 863-288-1458