# HEAVENLY HANDS HOMECARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245983444
- **Authorized official:** KEISHA JOHNSON (PRESIDENT/ADMIN)
- **Authorized official phone:** (817) 891-3217

## Contact information

- **Practice address:** 5009 BRENTWOOD STAIR RD STE 103, FORT WORTH, TX 76112-2859
- **Practice address phone:** (817) 888-3112
- **Practice address fax:** (817) 888-3112
- **Mailing address:** 5009 BRENTWOOD STAIR RD STE 103, FORT WORTH, TX 76112-2859
- **Mailing address phone:** (817) 888-3112
- **Mailing address fax:** (817) 888-3112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 372600000X | Adult Companion | — | NULL | — |
| 372600000X | Adult Companion | — | — | — |
| 3747P1801X | Personal Care Attendant | — | NULL | — |
| 3747P1801X | Personal Care Attendant | — | — | — |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |
| 376J00000X | Homemaker | — | NULL | — |
| 376J00000X | Homemaker | — | — | — |

## Other

- **Enumeration date:** 01/28/2022
- **Last updated:** 04/19/2023