Healthcare Provider Details

I. General information

NPI: 1902716111
Provider Name (Legal Business Name): BLAN HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 LA CROSSE AVE APT 2S
SKOKIE IL
60077-1949
US

IV. Provider business mailing address

8931 LA CROSSE AVE APT 2S
SKOKIE IL
60077-1949
US

V. Phone/Fax

Practice location:
  • Phone: 224-260-1182
  • Fax:
Mailing address:
  • Phone: 224-260-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BORIS NJIKE
Title or Position: PRESIDENT
Credential: CEO
Phone: 224-260-1182