Provider Demographics
NPI:1447078902
Name:SURE HAVEN LLC
Entity type:Organization
Organization Name:SURE HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:224-545-8579
Mailing Address - Street 1:PO BOX 3574
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-3574
Mailing Address - Country:US
Mailing Address - Phone:224-545-8579
Mailing Address - Fax:
Practice Address - Street 1:11 PARKLANDS DR UNIT 1637
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5192
Practice Address - Country:US
Practice Address - Phone:224-545-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Multi-Specialty