Organization
HEAVENLY IN HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE KELLY (ADMINISTRATOR)
(601) 274-2368
Entity
Organization
Contact information
Practice address
109 E DONALD ST STE 8, QUITMAN, MS 39355-2310
(601) 274-2368
Mailing address
109 E DONALD ST STE 8, QUITMAN, MS 39355-2310
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05
—
MS
Enumeration date
07/11/2017
Last updated
07/11/2017
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