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General NPI Number Information
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NPI Number | 1518359363
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Entity Type | Organization
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Legal Business Name | BLUE HAVEN ASSISTED LIVING, INC
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 35525 COUNTY ROAD 473
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City | LEESBURG
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State | FL
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Zip | 34788-6161
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Country | US
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Telephone | 352-314-0422
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Fax | 352-314-0423
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Provider Business Mailing Address
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Address Line | 33409 IRONGATE DR
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City | LEESBURG
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State | FL
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Zip | 34788-3158
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LEYTONYA HARGROVE
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Credential |
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Telephone | 352-409-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11984
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License Number State | FL
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