=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336017474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE HAVEN HOMES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 MCLEAN ST
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48203-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-438-8788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6311 HAGGERTY RD # 722
-----------------------------------------------------
City | W BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48322-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-438-8788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. TAMARA M EVANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-438-8788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------