Provider Demographics
NPI:1174909881
Name:HAVEN HEALTH CARE
Entity type:Organization
Organization Name:HAVEN HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:232-451-3391
Mailing Address - Street 1:1134 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3512
Mailing Address - Country:US
Mailing Address - Phone:323-451-3391
Mailing Address - Fax:
Practice Address - Street 1:2895 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2212
Practice Address - Country:US
Practice Address - Phone:562-426-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23831251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health