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General NPI Number Information
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NPI Number | 1215617568
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Entity Type | Organization
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Legal Business Name | HEAVENSENT PSA LLC
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 10484 N STATE ROAD 13 STE A
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City | ELWOOD
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State | IN
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Zip | 46036-8871
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Country | US
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Telephone | 765-557-8248
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Fax | 888-823-8384
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Provider Business Mailing Address
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Address Line | 10484 N STATE ROAD 13 STE A
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City | ELWOOD
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State | IN
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Zip | 46036-8871
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Country | US
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Telephone | 765-557-8248
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Fax | 888-823-8384
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Authorized Official
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Title or Position | ADMIN
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Name | MARY B MURPHY
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Credential |
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Telephone | 765-557-8249
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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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