Healthcare Provider Details

I. General information

NPI: 1407386071
Provider Name (Legal Business Name): HEAVEN SENT HOME HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W WESTERN AVE STE 132
SOUTH BEND IN
46619-3561
US

IV. Provider business mailing address

2015 W WESTERN AVE STE 132
SOUTH BEND IN
46619-3561
US

V. Phone/Fax

Practice location:
  • Phone: 574-229-8749
  • Fax: 574-855-1915
Mailing address:
  • Phone: 574-229-8749
  • Fax: 574-855-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-014155-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number14-014155-1
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number14-014155-1
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number14-014155-1
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number28217649A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number14-014155-1
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number14-014155-1
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number14-014155-1
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number14-014155-1
License Number StateIN
# 10
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number14-014155-1
License Number StateIN
# 11
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number14-014155-1
License Number StateIN
# 12
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number14-014155-1
License Number StateIN
# 13
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number14-014155-1
License Number StateIN

VIII. Authorized Official

Name: MRS. WANDA S BETANCOURT
Title or Position: OWNER
Credential: RN
Phone: 574-229-8749