Provider Demographics
NPI:1871349597
Name:QUALITY CARE HAVEN
Entity type:Organization
Organization Name:QUALITY CARE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IHUNWO KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-367-9208
Mailing Address - Street 1:4484 GERTRUDE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2824
Mailing Address - Country:US
Mailing Address - Phone:313-367-9208
Mailing Address - Fax:
Practice Address - Street 1:4484 GERTRUDE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2824
Practice Address - Country:US
Practice Address - Phone:313-367-9208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care