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General NPI Number Information
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NPI Number | 1982045159
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Entity Type | Organization
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Legal Business Name | VALENCIA'S HEAVENLY CREATIONS, LLC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 3005 KNIGHTBRIDGE RD
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City | COLUMBIA
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State | SC
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Zip | 29223-2130
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Country | US
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Telephone | 803-605-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1172
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City | COLUMBIA
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State | SC
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Zip | 29202-1172
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Country | US
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Telephone | 803-605-1234
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Fax |
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Authorized Official
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Title or Position | OWNER/CHAIRMAN OF THE BOARD
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Name | MRS. HELEN V. THOMAS
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Credential |
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Telephone | 803-605-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | SC
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