Healthcare Provider Details

I. General information

NPI: 1124948708
Provider Name (Legal Business Name): HEAVENLY HANDS HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 HILLARD LN
GREENVILLE NC
27858-8052
US

IV. Provider business mailing address

4120 HILLARD LN
GREENVILLE NC
27858-8052
US

V. Phone/Fax

Practice location:
  • Phone: 954-604-8600
  • Fax:
Mailing address:
  • Phone: 954-604-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LATOYA GREEN
Title or Position: SERVICE SUPERVISOR, RN
Credential: RN
Phone: 954-604-8600