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General NPI Number Information
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NPI Number | 1669664082
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Entity Type | Organization
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Legal Business Name | A HEAVENLY HOME HEALTHCARE AGENCY
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 430 COURTRIGHT DR
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City | PICKERINGTON
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State | OH
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Zip | 43147-1528
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Country | US
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Telephone | 614-917-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 430 COURTRIGHT DR
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City | PICKERINGTON
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State | OH
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Zip | 43147-1528
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Country | US
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Telephone | 614-917-9118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. STEPHANIE KIMBERLY STARKS
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Credential | B.S.
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Telephone | 614-917-9118
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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 | 2531906
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License Number State | OH
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