Healthcare Provider Details

I. General information

NPI: 1356030662
Provider Name (Legal Business Name): HEAVENLY CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 RUFFIN ST
NORFOLK VA
23504-2132
US

IV. Provider business mailing address

2424 RUFFIN ST
NORFOLK VA
23504-2132
US

V. Phone/Fax

Practice location:
  • Phone: 757-264-1381
  • Fax:
Mailing address:
  • Phone: 757-264-1381
  • Fax:

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

VIII. Authorized Official

Name: MS. MELISSA COUSAR
Title or Position: ASSISTANT ADMINISTRATOR
Credential: CNA
Phone: 757-264-1381