Heavenly Creations Adult Day Care LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

HEAVENLY CREATIONS ADULT DAY CARE LLC

Practice address

22008 109TH Ave
Queens Village, NY 11429-2515

Phone

(917) 226-7249

NPI assigned

Apr 15, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Maxine R HarrisNPI 1023377611

Title

Director/Owner

Phone

(917) 226-7249

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maxine Rosemarie Harris

  • Adult Care Home Facility
  • Queens Village, NY
  • NPI 1023377611
  NPD (past) Authorized official

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397520000000",
    "number": "1871912113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22008 109TH AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292515",
            "telephone_number": "917-226-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22008 109TH AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114292515",
            "telephone_number": "917-226-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY CREATIONS ADULT DAY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2014-04-15",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MAXINE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "917-226-7249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023377611",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mark Steven Heffron, D.C.
• Angela Hegarty
• Rajendraswamy Heggawadi, SLP
• Demar Hendricks
• Marie-Antoinette Henri

• Adult Day Care Clinic/Center in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Adult Day Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.