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General NPI Number Information
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NPI Number | 1417846833
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Entity Type | Organization
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Legal Business Name | HAVENCREST NETWORK LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 101 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-500-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 418 BROADWAY # 8611
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 631-500-0433
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | MR. CLIFFORD MICHEL
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Credential |
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Telephone | 631-500-0433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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