MEDICARE: HAVEN'S MANOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1083249817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN'S MANOR

Provider Business Mailing Address
First Line	:	6900 NW 34TH ST
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-8043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4609 SW MASEFIELD ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-8402
Country	:	US
Telephone Number	:	954-296-8699
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROCHELLE BOYD
Credential	:
Telephone Number	:	954-296-8699

Provider Enumeration Date	:	03/12/2020
Last Update Date	:	03/12/2020

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Directions to “HAVEN'S MANOR ” Practice Location

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