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General NPI Number Information
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NPI Number | 1083249817
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Entity Type | Organization
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Legal Business Name | HAVEN'S MANOR
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 4609 SW MASEFIELD ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-8402
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Country | US
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Telephone | 954-296-8699
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 NW 34TH ST
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City | MARGATE
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State | FL
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Zip | 33063-8043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROCHELLE BOYD
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Credential |
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Telephone | 954-296-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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