Healthcare Provider Details

I. General information

NPI: 1184366346
Provider Name (Legal Business Name): HEAVENLY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 WHITMAN CT
STONE MOUNTAIN GA
30083-2491
US

IV. Provider business mailing address

776 WHITMAN CT
STONE MOUNTAIN GA
30083-2491
US

V. Phone/Fax

Practice location:
  • Phone: 678-974-5494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNNE ROBINSON
Title or Position: OWNER
Credential:
Phone: 678-974-5494