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Organization

HEAVENLY HEALTHCARE AGENCY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. ANTOINETTA D FULTON (OWNER)
(336) 230-0808
Entity
Organization

Contact information

Practice address
503 W MCGEE ST, GREENSBORO, NC 27401-2702
(336) 230-0808
(336) 230-0842
Mailing address
503 W MCGEE ST, GREENSBORO, NC 27401-2702
(336) 230-0808
(336) 230-0842

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HC2337
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3409611
NC
05
6600937
NC
Enumeration date
10/13/2006
Last updated
08/22/2020
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