Healthcare Provider Details

I. General information

NPI: 1912661422
Provider Name (Legal Business Name): HEAVENS HANDS HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BACON ST UNIT C
IRWINTON GA
31042-2561
US

IV. Provider business mailing address

103 BACON ST UNIT C
IRWINTON GA
31042-2561
US

V. Phone/Fax

Practice location:
  • Phone: 478-946-2273
  • Fax: 478-946-1000
Mailing address:
  • Phone: 478-946-2273
  • Fax: 478-946-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA MARCELUS
Title or Position: OWNER
Credential: RN
Phone: 404-803-7603