Provider Demographics
NPI:1164239844
Name:HEAVENLY CARE LLC
Entity type:Organization
Organization Name:HEAVENLY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:EZRA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-596-6027
Mailing Address - Street 1:57 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2532
Mailing Address - Country:US
Mailing Address - Phone:347-596-6027
Mailing Address - Fax:
Practice Address - Street 1:57 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2532
Practice Address - Country:US
Practice Address - Phone:347-596-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty