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General NPI Number Information
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NPI Number | 1972646693
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Entity Type | Organization
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Legal Business Name | HAVEN MANOR, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4848 S 48TH ST STE. 2
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City | LINCOLN
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State | NE
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Zip | 68516-1290
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Country | US
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Telephone | 402-434-2680
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Fax | 402-434-2683
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Provider Business Mailing Address
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Address Line | PO BOX 6125
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City | LINCOLN
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State | NE
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Zip | 68506-0125
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Country | US
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Telephone | 402-434-2680
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Fax | 402-434-2683
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Authorized Official
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Title or Position | TRAINING PROGRAM SUPERVISOR
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Name | MRS. SARAH R FISCHER
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Credential | L.A.
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Telephone | 402-434-2680
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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 | 6681603
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License Number State | NE
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