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General NPI Number Information
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NPI Number | 1770005837
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Entity Type | Organization
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Legal Business Name | HEAVENLY IN HOMECARE LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 109 E DONALD ST STE 8
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City | QUITMAN
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State | MS
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Zip | 39355-2310
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Country | US
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Telephone | 601-274-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 109 E DONALD ST STE 8
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City | QUITMAN
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State | MS
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Zip | 39355-2310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHARLENE KELLY
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Credential |
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Telephone | 601-274-2368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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