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General NPI Number Information
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NPI Number | 1477406536
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Entity Type | Organization
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Legal Business Name | HERITAGE HAVEN HOME
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 6031 AVON ST
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City | PORTAGE
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State | MI
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Zip | 49024-2627
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Country | US
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Telephone | 269-532-4520
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Fax | 206-657-5255
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Provider Business Mailing Address
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Address Line | 6031 AVON ST
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City | PORTAGE
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State | MI
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Zip | 49024-2627
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Country | US
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Telephone | 269-532-4520
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Fax | 206-665-5255
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BOLAJI S INUOLAJI
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Credential |
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Telephone | 269-532-4520
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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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