Healthcare Provider Details

I. General information

NPI: 1841527108
Provider Name (Legal Business Name): HEAVEN SENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 ALDEA AVE NW
ALBUQUERQUE NM
87114-5883
US

IV. Provider business mailing address

5515 CATALONIA CT NW
ALBUQUERQUE NM
87114-1425
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-8203
  • Fax:
Mailing address:
  • Phone: 505-803-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberIT2159
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberIT2159
License Number StateNM

VIII. Authorized Official

Name: MR. STEVE L GROSS
Title or Position: OWNER
Credential:
Phone: 505-803-1911