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General NPI Number Information
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NPI Number | 1700115912
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Entity Type | Organization
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Legal Business Name | HEAVENLY WORKS HOME HEALTH CARE SERVICES
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 5040 VIRGINIA BEACH BLVD 103
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City | VIRGINIA BCH
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State | VA
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Zip | 23462-6637
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Country | US
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Telephone | 757-718-7355
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Fax | 757-961-8744
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Provider Business Mailing Address
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Address Line | 5040 VIRGINIA BEACH BLVD 103
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City | VIRGINIA BCH
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State | VA
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Zip | 23462-6637
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Country | US
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Telephone | 757-718-7355
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Fax | 757-961-8744
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Authorized Official
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Title or Position | NURSE ADMINISTRATOR
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Name | MS. WANDA RENNE RIDDICK
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Credential | 99 CREDITS
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Telephone | 757-717-1785
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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 | 128291
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License Number State | VA
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