Healthcare Provider Details

I. General information

NPI: 1467284760
Provider Name (Legal Business Name): DS HEAVENLY HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 HEAVENLY HAVEN DR
OWOSSO MI
48867-9761
US

IV. Provider business mailing address

PO BOX 606
OWOSSO MI
48867-0606
US

V. Phone/Fax

Practice location:
  • Phone: 989-627-7188
  • Fax:
Mailing address:
  • Phone: 989-627-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: SHERRI MARIE SEMANS
Title or Position: OWNER
Credential:
Phone: 989-627-7718