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General NPI Number Information
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NPI Number | 1306636881
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Entity Type | Organization
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Legal Business Name | HAVEN KARES LLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1256 CAMP JACKSON RD
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City | CAHOKIA
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State | IL
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Zip | 62206-2232
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Country | US
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Telephone | 618-696-8237
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Fax |
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Provider Business Mailing Address
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Address Line | 9311 CIRCLE DR
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City | BELLEVILLE
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State | IL
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Zip | 62223-1610
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Country | US
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Telephone | 618-570-2126
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARONDA A COLEMAN
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Credential | NP
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Telephone | 618-570-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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