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General NPI Number Information
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NPI Number | 1336401645
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Entity Type | Organization
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Legal Business Name | EDEN HAVEN LLC
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 317 N SAGE ST
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City | KALAMAZOO
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State | MI
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Zip | 49006-4040
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Country | US
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Telephone | 269-806-5459
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Fax |
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Provider Business Mailing Address
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Address Line | 1339 KINGSTON AVE
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City | KALAMAZOO
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State | MI
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Zip | 49001-5101
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Country | US
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Telephone | 269-806-5459
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSEE
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Name | MS. SIBONGINKOSI OSEI
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Credential |
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Telephone | 269-806-5456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | AS390314539
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License Number State | MI
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