Healthcare Provider Details

I. General information

NPI: 1982045159
Provider Name (Legal Business Name): VALENCIA'S HEAVENLY CREATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 KNIGHTBRIDGE RD
COLUMBIA SC
29223-2130
US

IV. Provider business mailing address

PO BOX 1172
COLUMBIA SC
29202-1172
US

V. Phone/Fax

Practice location:
  • Phone: 803-605-1234
  • Fax:
Mailing address:
  • Phone: 803-605-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. HELEN V. THOMAS
Title or Position: OWNER/CHAIRMAN OF THE BOARD
Credential:
Phone: 803-605-1234