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General NPI Number Information
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NPI Number | 1588450530
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Entity Type | Organization
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Legal Business Name | ANDRE HEAVENLY HOMECARE AGENCY
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 8892 LOUISIANA ST STE A
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7153
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Country | US
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Telephone | 708-960-4529
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Fax | 708-312-5399
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Provider Business Mailing Address
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Address Line | 8892 LOUISIANA ST STE A
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7153
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Country | US
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Telephone | 708-960-4529
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Fax | 708-312-5399
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Authorized Official
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Title or Position | C.E.O
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Name | BRITTANY REYNOLDS
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Credential |
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Telephone | 708-856-5317
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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 |
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License Number State |
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