Provider Demographics
NPI:1447972625
Name:HEALING HAVEN HOMES LLC
Entity type:Organization
Organization Name:HEALING HAVEN HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOI
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:703-554-7829
Mailing Address - Street 1:1344 GRAND TETON DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2939
Mailing Address - Country:US
Mailing Address - Phone:469-397-0778
Mailing Address - Fax:469-397-0779
Practice Address - Street 1:1344 GRAND TETON DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2939
Practice Address - Country:US
Practice Address - Phone:469-397-0778
Practice Address - Fax:469-397-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility