Healthcare Provider Details

I. General information

NPI: 1730896663
Provider Name (Legal Business Name): LOGAN'S HEAVENLY CARE SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 SE 136TH PL
SUMMERFIELD FL
34491-2224
US

IV. Provider business mailing address

748 BRYNLE CT
DEBARY FL
32713-0116
US

V. Phone/Fax

Practice location:
  • Phone: 352-630-5626
  • Fax: 321-256-5097
Mailing address:
  • Phone: 352-630-5626
  • Fax: 321-256-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NATASHA GRACE
Title or Position: CEO
Credential:
Phone: 352-630-5626