Healthcare Provider Details

I. General information

NPI: 1679205819
Provider Name (Legal Business Name): ANDRE HEAVENLY HOMECARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 GOVERNORS DR FL 3
OLYMPIA FIELDS IL
60461-1032
US

IV. Provider business mailing address

20200 GOVERNORS DR FL 3
OLYMPIA FIELDS IL
60461-1032
US

V. Phone/Fax

Practice location:
  • Phone: 708-856-5317
  • Fax: 708-312-5399
Mailing address:
  • Phone: 708-856-5317
  • Fax: 708-312-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY REYNOLDS
Title or Position: CEO/MANAGER
Credential:
Phone: 708-856-5317