Provider Demographics
NPI:1114731130
Name:ADARYL HEAVEN HEALTHCARE LLC
Entity type:Organization
Organization Name:ADARYL HEAVEN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTHCARE WORKER
Authorized Official - Phone:864-567-0877
Mailing Address - Street 1:134 CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-9227
Mailing Address - Country:US
Mailing Address - Phone:864-567-0877
Mailing Address - Fax:
Practice Address - Street 1:134 CAMDEN DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-9227
Practice Address - Country:US
Practice Address - Phone:864-567-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health