MEDICARE: HEAVENLY HOSPICE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1902286925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HOSPICE CARE

Provider Business Mailing Address
First Line	:	2174 S 600 W
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-8986
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2174 S 600 W
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-8986
Country	:	US
Telephone Number	:	317-534-7728
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDIE FAUGHT
Credential	:
Telephone Number	:	317-534-7728

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/04/2015

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Directions to “HEAVENLY HOSPICE CARE ” Practice Location

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