Provider Demographics
NPI:1043045560
Name:HEAVENLY ANGELS LLC.
Entity type:Organization
Organization Name:HEAVENLY ANGELS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-412-6468
Mailing Address - Street 1:22971 ALGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3807
Mailing Address - Country:US
Mailing Address - Phone:313-412-6468
Mailing Address - Fax:313-447-2009
Practice Address - Street 1:22971 ALGER ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3807
Practice Address - Country:US
Practice Address - Phone:313-412-6468
Practice Address - Fax:313-447-2009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMIKA WILLIAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health