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General NPI Number Information
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NPI Number | 1487494373
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Entity Type | Organization
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Legal Business Name | HAVEN ON EARTH
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 122 S 4TH ST
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City | LINDENHURST
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State | NY
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Zip | 11757-4725
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Country | US
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Telephone | 561-577-2116
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Fax |
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Provider Business Mailing Address
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Address Line | 65 E HOFFMAN AVE UNIT 121
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City | LINDENHURST
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State | NY
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Zip | 11757-8005
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Country | US
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Telephone | 561-577-2116
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NORDA L BARNES
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Credential |
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Telephone | 561-577-2116
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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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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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