Provider Demographics
NPI:1104546902
Name:HEAVENS ANGELS SERVICES LLC
Entity type:Organization
Organization Name:HEAVENS ANGELS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SEIVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-471-7025
Mailing Address - Street 1:1405 LEO JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-4734
Mailing Address - Country:US
Mailing Address - Phone:186-471-7025
Mailing Address - Fax:863-884-1461
Practice Address - Street 1:1405 LEO JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-4734
Practice Address - Country:US
Practice Address - Phone:186-471-7025
Practice Address - Fax:863-884-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care