Provider Demographics
NPI:1447253661
Name:HAVEN HOMES, INC.
Entity type:Organization
Organization Name:HAVEN HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SEELOCHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:STADTHERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-855-5041
Mailing Address - Street 1:4848 GATEWAY BLVD
Mailing Address - Street 2:MAPLE PLAIN
Mailing Address - City:MAPLE PLAIN
Mailing Address - State:MN
Mailing Address - Zip Code:55359
Mailing Address - Country:US
Mailing Address - Phone:763-292-2300
Mailing Address - Fax:763-479-3656
Practice Address - Street 1:1520 WYMAN AVE
Practice Address - Street 2:
Practice Address - City:MAPLE PLAIN
Practice Address - State:MN
Practice Address - Zip Code:55359-9639
Practice Address - Country:US
Practice Address - Phone:763-479-1993
Practice Address - Fax:763-479-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN325307314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN064742000Medicaid
MN245497Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER