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General NPI Number Information
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NPI Number | 1326674888
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Entity Type | Organization
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Legal Business Name | HAVEN LEE HOMES LLC
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 760 WATTLES RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-3279
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Country | US
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Telephone | 248-550-6544
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Fax |
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Provider Business Mailing Address
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Address Line | 760 WATTLES RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-3279
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Country | US
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Telephone | 248-550-6544
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANDREA AGUDELO
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Credential | ADMINISTRATOR
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Telephone | 248-885-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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