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General NPI Number Information
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NPI Number | 1477799021
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Entity Type | Organization
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Legal Business Name | HEAVENLY HOME HEALTH, INC.
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Dates
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Enumeration Date | 01/04/2009
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 805 E BROADWAY STE H
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City | GLENDALE
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State | CA
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Zip | 91205-4539
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Country | US
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Telephone | 818-500-9007
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Fax | 818-500-9052
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Provider Business Mailing Address
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Address Line | 805 E BROADWAY STE H
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City | GLENDALE
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State | CA
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Zip | 91205-4539
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Country | US
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Telephone | 818-500-9007
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Fax | 818-500-9052
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. GERARDO B. SANTILLAN
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Credential | R.N.
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Telephone | 818-500-9007
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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 | 550001026
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License Number State | CA
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