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General NPI Number Information
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NPI Number | 1376691659
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Entity Type | Organization
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Legal Business Name | HEAVENLY HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 102 S. WILSON AVE STE H
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City | DUNN
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State | NC
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Zip | 28334-4960
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Country | US
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Telephone | 910-978-8388
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Fax | 910-892-2987
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Provider Business Mailing Address
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Address Line | 102 S. WILSON AVE STE H
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City | DUNN
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State | NC
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Zip | 28334-4960
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Country | US
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Telephone | 910-978-8388
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Fax | 910-892-2987
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | GERALDINE MC NEILL
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Credential |
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Telephone | 910-978-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC3627
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC3627
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License Number State | NC
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