Healthcare Provider Details

I. General information

NPI: 1093738379
Provider Name (Legal Business Name): HEAVENLY HOST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 S BRYAN BELT LINE RD
MESQUITE TX
75149-5031
US

IV. Provider business mailing address

536 S BRYAN BELT LINE RD
MESQUITE TX
75149-5031
US

V. Phone/Fax

Practice location:
  • Phone: 972-289-3800
  • Fax: 972-289-3801
Mailing address:
  • Phone: 972-289-3800
  • Fax: 972-289-3801

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: VIJI ANTONY
Title or Position: DIRECTOR
Credential:
Phone: 972-289-3800