Healthcare Provider Details

I. General information

NPI: 1225982671
Provider Name (Legal Business Name): STONEHAVEN VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 DOVER ST
SAINT LOUIS MO
63111-2210
US

IV. Provider business mailing address

207 DOVER ST
SAINT LOUIS MO
63111-2210
US

V. Phone/Fax

Practice location:
  • Phone: 314-873-8851
  • Fax: 314-873-8851
Mailing address:
  • Phone: 314-873-8851
  • Fax: 314-873-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL BORO
Title or Position: MANAGING MEMBER
Credential:
Phone: 314-873-8851