Organization
HEAVENLY HEALTHCARE AGENCY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANTOINETTA D FULTON (ADMINISTRATOR DIRECTOR)
(336) 230-0808
Entity
Organization
Contact information
Practice address
110 EXCHANGE ST, SUITE I, DANVILLE, VA 24541
(434) 799-5378
(434) 799-5379
Mailing address
PO BOX 13531, GREENSBORO, NC 27415-3531
(336) 230-0808
(336) 230-0842
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
HC2337
NC
Other
Enumeration date
06/17/2008
Last updated
06/17/2008
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