MEDICARE: HEAVENLY HANDS CARETAKERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174200000X	Meals Provider
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063282622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HANDS CARETAKERS LLC

Provider Business Mailing Address
First Line	:	1609 E MOUNT PLEASANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1208
Country	:	US
Telephone Number	:	267-266-3267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 E MOUNT PLEASANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1208
Country	:	US
Telephone Number	:	267-266-3267
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	PRIYA CAVANAUGH
Credential	:
Telephone Number	:	484-954-9329

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/04/2024

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