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NPI Code Detail

MEDICARE: HEAVENLY HAVEN

MEDICARE: HEAVENLY HAVEN
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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility7254LA

Other Identifiers

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

General Provider Information

NPI Number : 1457474470
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEAVENLY HAVEN
Provider Business Mailing Address
First Line : 4824 E BROOKSTOWN DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-3823
Country : US
Telephone Number : 225-357-7206
Fax Number : 225-357-6424
Provider Business Practice Location Address
First Line : 4824 E BROOKSTOWN DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70805-3823
Country : US
Telephone Number : 225-357-7206
Fax Number : 225-357-6424
Authorized Official
Title or Position : CEO
Name : MRS. DOROTHY M NELSON
Credential :
Telephone Number : 225-357-5126
Provider Enumeration Date : 04/06/2007
Last Update Date : 03/14/2008

Similar Medicare Providers

1396702866 — HEAVENLY HAVEN, INC.
Practice Location Address:
4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
Practice Phone: 225-357-7206
Practice Fax: 255-357-6424
1740318799 — HEAVENLY HAVEN
Practice Location Address:
4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
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Practice Fax:
1952424194 — HEAVENLY HAVEN
Practice Location Address:
4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
Practice Phone: 225-357-7206
Practice Fax: 225-357-6424
1861515009 — HEAVENLY HAVEN
Practice Location Address:
4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
Practice Phone: 225-357-7206
Practice Fax: 225-357-6424
1942323183 — HEAVENLY HAVEN
Practice Location Address:
4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
Practice Phone: 225-357-7206
Practice Fax: 225-357-6424
1659577922 — HEAVENLY HAVEN
Practice Location Address:
4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
Practice Phone: 225-357-7206
Practice Fax: 225-357-6424

Directions to “HEAVENLY HAVEN ” Practice Location

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