Heavenly Healthcare Services, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

HEAVENLY HEALTHCARE SERVICES, INC

Practice address

6470 Van Nuys Blvd Ste E
Van Nuys, CA 91401-1499

Phone

(818) 671-1757

Fax

(818) 671-1405

NPI assigned

Oct 10, 2021

Organization subpart

No

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

Authorized official

Name

Samuel Kesablyan

Title

Ceo

Phone

(818) 671-1757

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 757330

Legal name

HEAVENLY HEALTHCARE SERVICES INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 8, 2023

Last certification

Jul 28, 2023

Organization structure

CorporationProprietary

Incorporated

Sep 8, 2021 in CA

Enrollment address

6470 Van Nuys Blvd
Ste E
Van Nuys, CA 91401-1499

Listed as

Heavenly Healthcare Services, IncCCN 757330 · All quality measures

Ownership

-

Certified

Aug 8, 2023

Medicare certification status

ActiveFrom the Provider of Services file

All disclosed owners & managing parties 1

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

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

{
    "created_epoch": "1633824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1598427288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6470 VAN NUYS BLVD STE E",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914011499",
            "telephone_number": "818-671-1757",
            "fax_number": "818-671-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6470 VAN NUYS BLVD STE E",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914011499",
            "telephone_number": "818-671-1757",
            "fax_number": "818-671-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY HEALTHCARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-10",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "KESABLYAN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-671-1757"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.