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General NPI Number Information
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NPI Number | 1104546902
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Entity Type | Organization
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Legal Business Name | HEAVENS ANGELS SERVICES LLC
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 1405 LEO JEFFERSON AVE
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City | AVON PARK
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State | FL
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Zip | 33825-4734
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Country | US
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Telephone | 186-471-7025
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Fax | 863-884-1461
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Provider Business Mailing Address
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Address Line | 1405 LEO JEFFERSON AVE
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City | AVON PARK
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State | FL
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Zip | 33825-4734
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Country | US
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Telephone | 186-471-7025
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Fax | 863-884-1461
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | SEIVEY SPRY
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Credential |
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Telephone | 863-471-7025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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