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General NPI Number Information
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NPI Number | 1962661561
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Entity Type | Organization
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Legal Business Name | HAVENS GATEWAY PERSONAL CARE FACILITY INC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 1200 S ACADIAN THRUWAY 212
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City | BATON ROUGE
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State | LA
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Zip | 70806-6900
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Country | US
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Telephone | 225-343-4740
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Fax | 225-343-4742
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Provider Business Mailing Address
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Address Line | 1200 S ACADIAN THRUWAY 212
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City | BATON ROUGE
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State | LA
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Zip | 70806-6900
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Country | US
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Telephone | 225-343-4740
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Fax | 225-343-4742
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MRS. ALFREDA CARTER JACKSON
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Credential | BA
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Telephone | 225-343-4740
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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 | PCA 6770
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License Number State | LA
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