MEDICARE: HEAVENLY CARE, INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1780824318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY CARE, INC.

Provider Business Mailing Address
First Line	:	12880 SW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-1308
Country	:	US
Telephone Number	:	305-490-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	12880 SW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-1308
Country	:	US
Telephone Number	:	305-490-9740
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAREINI GARCIA ALFONSO
Credential	:
Telephone Number	:	305-490-9740

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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