NPIMap

Organization Active NPI

Heaven's Angels Health Care Services Inc.

  • Home Health Agency
  • Lincolnwood, IL
National Provider Identifier
1316030695
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1010563 Issued in IL
Legal business name
HEAVEN'S ANGELS HEALTH CARE SERVICES INC.
Practice address
7366 N Lincoln Ave
Suite 202
Lincolnwood, IL 60712-1708
Phone
(847) 679-7682
Fax
(847) 679-7685
NPI assigned
Oct 1, 2006
Last updated
Jan 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Raphidien Lucena Dawis
Title
Administrator/President
Phone
(847) 679-7682

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1010563 IL Primary

Addresses

Primary practice location

7366 N Lincoln Ave
Suite 202
Lincolnwood, IL 60712-1708

Mailing address

7366 N Lincoln Ave
Suite 202
Lincolnwood, IL 60712-1708
Phone (847) 679-7682

Other identifiers 1

IdentifierTypeStateIssuer
1010563OtherILSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090630000602 IL Part A Provider - Home Health Agency 5395896443 Practice locations: Lincolnwood, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316030695. Details of each certification follow.

Home health agency certification: CCN 148054

Legal name
HEAVEN'S ANGELS HEALTH CARE SERVICES INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 14, 2009
Last certification
Jun 22, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Oct 3, 2005 in IL
Enrollment address
7366 N Lincoln Avenue
Suite 202
Lincolnwood, IL 60712-2101

Care Compare: Home health agency

Medicare Care Compare
Listed as
Heaven's Angels Health Care Services IncCCN 148054 · All quality measures
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
May 14, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

7366 N Lincoln Ave
Ste 202
Lincolnwood, IL 60712
Phone (847) 679-7682

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Heaven's Angels Health Care Services Inc. Organization, Lincolnwood, IL For-profit 5% Or Greater Direct Ownership Interest Nov 1, 2005 60%
Operational/Managerial Control Nov 1, 2005 40%
Emmeline Dawis Individual W-2 Managing EmployeeDirector of Nursing Feb 4, 2006 5%
Raphidien Dawis Individual 5% Or Greater Direct Ownership InterestPresident/Admin Nov 1, 2005 40%
Corporate Director Nov 1, 2005

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1316030695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7366 N LINCOLN AVE",
            "address_2": "SUITE 202",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607121708",
            "telephone_number": "847-679-7682",
            "fax_number": "847-679-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7366 N LINCOLN AVE",
            "address_2": "SUITE 202",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607121708",
            "telephone_number": "847-679-7682",
            "fax_number": "847-679-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVEN'S ANGELS HEALTH CARE SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-01",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "DAWIS",
        "authorized_official_first_name": "RAPHIDIEN",
        "authorized_official_middle_name": "LUCENA",
        "authorized_official_title_or_position": "ADMINISTRATOR/PRESIDENT",
        "authorized_official_telephone_number": "847-679-7682",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1010563",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincolnwood, IL

Sources for this page

Verify at the official NPI Registry.