MEDICARE: HEAVENLY HOME HEALTH CARE

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	015349	VA

General Provider Information

NPI Number	:	1801151576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	707 GITTINGS ST
Second Line	:	SUITE 130
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6101
Country	:	US
Telephone Number	:	757-944-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 GITTINGS ST
Second Line	:	SUITE 130
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6101
Country	:	US
Telephone Number	:	757-944-0096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FREDERICK LEON JENKINS
Credential	:
Telephone Number	:	757-944-0096

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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Directions to “HEAVENLY HOME HEALTH CARE ” Practice Location

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