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General NPI Number Information
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NPI Number | 1801151576
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Entity Type | Organization
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Legal Business Name | HEAVENLY HOME HEALTH CARE
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 707 GITTINGS ST SUITE 130
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City | SUFFOLK
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State | VA
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Zip | 23434-6101
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Country | US
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Telephone | 757-944-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 707 GITTINGS ST SUITE 130
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City | SUFFOLK
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State | VA
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Zip | 23434-6101
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Country | US
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Telephone | 757-944-0096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. FREDERICK LEON JENKINS
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Credential |
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Telephone | 757-944-0096
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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 | 015349
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License Number State | VA
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