Provider Demographics
NPI:1417788050
Name:HEAVEN HOME CARE LLC
Entity type:Organization
Organization Name:HEAVEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILYAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:VEYSALOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-218-5827
Mailing Address - Street 1:3919 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3840
Mailing Address - Country:US
Mailing Address - Phone:814-218-5827
Mailing Address - Fax:
Practice Address - Street 1:1401 PARADE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1127
Practice Address - Country:US
Practice Address - Phone:814-218-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care