MEDICARE: HAPPY HAVEN HOMES INC.

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	261QA0600X	Adult Day Care Clinic/Center	5294	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174848881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY HAVEN HOMES INC.

Provider Business Mailing Address
First Line	:	42630 HINSON RD
Second Line	:	P.O. BOX 3092
City	:	HAMMOND
State	:	LA
Zip	:	70403-3216
Country	:	US
Telephone Number	:	985-543-0574
Fax Number	:	985-542-2832

Provider Business Practice Location Address
First Line	:	10454 ROCK RD
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-2932
Country	:	US
Telephone Number	:	225-567-3939
Fax Number	:	985-542-2832

Authorized Official
Title or Position	:	ASST. ADMIN
Name	:	MR. RANDALL SMITH
Credential	:
Telephone Number	:	985-543-0574

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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