=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912661422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAVENS HANDS HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2021
-----------------------------------------------------
Last Update Date | 03/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 BACON ST UNIT C
-----------------------------------------------------
City | IRWINTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31042-2561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-946-2273
-----------------------------------------------------
Fax | 478-946-1000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 BACON ST UNIT C
-----------------------------------------------------
City | IRWINTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31042-2561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-946-2273
-----------------------------------------------------
Fax | 478-946-1000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CASSANDRA MARCELUS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 404-803-7603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------