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General NPI Number Information
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NPI Number | 1164048963
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Entity Type | Organization
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Legal Business Name | HEAVEN HEALTH LLC
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 1781 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4383
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Country | US
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Telephone | 561-451-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 11303 TEMPLE ST
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City | COOPER CITY
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State | FL
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Zip | 33330-4442
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Country | US
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Telephone | 561-451-6464
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. YANNET DIEGUEZ RODRIGUEZ
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Credential |
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Telephone | 561-451-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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