Healthcare Provider Details

I. General information

NPI: 1740103563
Provider Name (Legal Business Name): HAUS HAVEN COLLECTIVE CONSTRUCTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18711 CLOVERSTONE CIR
CORNELIUS NC
28031-5659
US

IV. Provider business mailing address

19825-B NORTH COVE ROAD UNIT 1018
CORNELIUS NC
28031
US

V. Phone/Fax

Practice location:
  • Phone: 980-430-4380
  • Fax:
Mailing address:
  • Phone: 980-430-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT NOOSE
Title or Position: CO-OWNER
Credential:
Phone: 980-430-4380