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General NPI Number Information
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NPI Number | 1063978211
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL HAVEN LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 4804 W ST KATERI DR
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City | LAVEEN
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State | AZ
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Zip | 85339-8202
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Country | US
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Telephone | 602-831-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 W ST KATERI DR
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City | LAVEEN
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State | AZ
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Zip | 85339-8202
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Country | US
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Telephone | 602-831-8280
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TESFAYE TESEMA
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Credential |
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Telephone | 602-831-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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