Healthcare Provider Details

I. General information

NPI: 1104691583
Provider Name (Legal Business Name): HARBOR HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 COUNTY ROAD 34
CROSSVILLE AL
35962-3334
US

IV. Provider business mailing address

819 COUNTY ROAD 34
CROSSVILLE AL
35962-3334
US

V. Phone/Fax

Practice location:
  • Phone: 256-302-9721
  • Fax: 256-910-0819
Mailing address:
  • Phone: 256-302-9721
  • Fax: 256-910-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANDRA LEMONS
Title or Position: OWNER
Credential:
Phone: 256-302-9721