=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528649092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAVENLY CARES HOME HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2021
-----------------------------------------------------
Last Update Date | 04/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7959 COTTAGE HILL RD APT 1311
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36695-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-599-2028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7959 COTTAGE HILL RD APT 1311
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36695-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-599-2028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O
-----------------------------------------------------
Name | NYOKIE I KNIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-599-2028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------