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General NPI Number Information
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NPI Number | 1447117395
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Entity Type | Organization
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Legal Business Name | ASM HAVEN
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 2127 VAN ANTWERP ST
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-1624
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Country | US
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Telephone | 313-502-8402
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Fax |
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Provider Business Mailing Address
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Address Line | 2127 VAN ANTWERP ST
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-1624
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Country | US
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Telephone | 313-502-8402
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AYNAHSHA SAMONE SMITH MATON
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Credential |
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Telephone | 313-502-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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