Provider Demographics
NPI:1861077026
Name:HEAVENLY HOMECARE AGENCY LLC
Entity type:Organization
Organization Name:HEAVENLY HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCZEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-969-8969
Mailing Address - Street 1:5700 LAKE WORTH RD STE 201-Q
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3204
Mailing Address - Country:US
Mailing Address - Phone:561-969-8969
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD STE 201-Q
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3204
Practice Address - Country:US
Practice Address - Phone:561-969-8969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty