Healthcare Provider Details

I. General information

NPI: 1346068277
Provider Name (Legal Business Name): HEAVENLY PLACES HOME CARE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7021 MAHANT WAY
ELKRIDGE MD
21075-5460
US

IV. Provider business mailing address

7021 MAHANT WAY
ELKRIDGE MD
21075-5460
US

V. Phone/Fax

Practice location:
  • Phone: 301-356-7034
  • Fax:
Mailing address:
  • Phone: 301-356-7034
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. YVONNE KUBI
Title or Position: ADMINISTRATIOR
Credential:
Phone: 301-356-7034