Provider Demographics
NPI:1861536088
Name:HEAVENLY PROVIDERS HEALTH CARE, INC
Entity type:Organization
Organization Name:HEAVENLY PROVIDERS HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUSSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-849-9521
Mailing Address - Street 1:8402 REDCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-7949
Mailing Address - Country:US
Mailing Address - Phone:713-849-9521
Mailing Address - Fax:
Practice Address - Street 1:8402 REDCLIFF RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-7949
Practice Address - Country:US
Practice Address - Phone:713-849-9521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010640251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010640Medicaid