Healthcare Provider Details

I. General information

NPI: 1104414549
Provider Name (Legal Business Name): HEAVENLY SENT HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MCCULLOUGH DR STE 400
CHARLOTTE NC
28262-1336
US

IV. Provider business mailing address

301 MCCULLOUGH DR STE 400
CHARLOTTE NC
28262-1336
US

V. Phone/Fax

Practice location:
  • Phone: 704-576-1743
  • Fax: 704-559-2377
Mailing address:
  • Phone: 704-576-1743
  • Fax: 704-559-2377

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KAREN ELIZABETH BAILEY
Title or Position: OWNER / ADMINISTRATOR
Credential:
Phone: 704-576-1743