Healthcare Provider Details

I. General information

NPI: 1013270990
Provider Name (Legal Business Name): HAVEN'S HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 06/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 BAVARIAN ST
MIDDLETOWN OH
45044-3106
US

IV. Provider business mailing address

492 BAVARIAN ST
MIDDLETOWN OH
45044-3106
US

V. Phone/Fax

Practice location:
  • Phone: 888-959-1468
  • Fax:
Mailing address:
  • Phone: 513-649-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. LOREATHA L STANBACK
Title or Position: ALLIED HEALTH INSTRUCTOR
Credential: RMA, BHCM, MHCB
Phone: 18889591468