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General NPI Number Information
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NPI Number | 1245677780
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Entity Type | Organization
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Legal Business Name | HAVENCREST ALF, LLC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 4471 COCONUT CREEK BLVD
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1742
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Country | US
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Telephone | 954-971-4289
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Fax | 954-345-7123
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Provider Business Mailing Address
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Address Line | 4471 COCONUT CREEK BLVD
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1742
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Country | US
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Telephone | 954-971-4289
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Fax | 954-345-7123
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Authorized Official
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Title or Position | OWNER
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Name | YVONNE JOHNSON
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Credential |
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Telephone | 954-683-3945
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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 | AL10229
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License Number State | FL
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