Provider Demographics
NPI:1194185868
Name:HEAVENLY HOME CARE
Entity type:Organization
Organization Name:HEAVENLY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-354-7098
Mailing Address - Street 1:9 WILLIAM MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1850
Mailing Address - Country:US
Mailing Address - Phone:781-654-5402
Mailing Address - Fax:
Practice Address - Street 1:9 WILLIAM MORRISON DRIVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-654-5402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health