Provider Demographics
NPI:1588145163
Name:HEAVEN LEE HANDS HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:HEAVEN LEE HANDS HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PCA
Authorized Official - Phone:804-787-4499
Mailing Address - Street 1:3002 FENDALL AVE APT B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2608
Mailing Address - Country:US
Mailing Address - Phone:804-787-4499
Mailing Address - Fax:
Practice Address - Street 1:527 N LABURNUM AVE APT 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2943
Practice Address - Country:US
Practice Address - Phone:804-787-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 3747P1801X, 385H00000X
VAH18667014251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty