Provider Demographics
NPI:1043616451
Name:HAVEN HOME HEALTH CARE 5, LLC
Entity type:Organization
Organization Name:HAVEN HOME HEALTH CARE 5, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-428-4644
Mailing Address - Street 1:970 LAKE CARILLON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1129
Mailing Address - Country:US
Mailing Address - Phone:844-428-4644
Mailing Address - Fax:
Practice Address - Street 1:970 LAKE CARILLON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1129
Practice Address - Country:US
Practice Address - Phone:844-428-4644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health