MEDICARE: HEAVENLY HANDS CONSULTANT SERVICES,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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1447790142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HANDS CONSULTANT SERVICES,LLC

Provider Business Mailing Address
First Line	:	750 SOUTH ORANGE BLOSSOM TRAIL SUITE 236
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805
Country	:	US
Telephone Number	:	407-717-4164
Fax Number	:	407-205-1188

Provider Business Practice Location Address
First Line	:	750 S ORANGE BLOSSOM TRL STE 236
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3196
Country	:	US
Telephone Number	:	407-717-4164
Fax Number	:	407-205-1188

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DANITA COBB
Credential	:
Telephone Number	:	407-717-4164

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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