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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
1251E00000XHome Health Agency7258LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11174432OTHERLAPCS

General Provider Information

NPI Number : 1740318799
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 :
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 :
Authorized Official
Title or Position : CEO
Name : MRS. DOROTHY M NESLON
Credential :
Telephone Number : 225-357-7206
Provider Enumeration Date : 03/01/2007
Last Update Date : 03/14/2008

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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
1457474470 — HEAVENLY HAVEN
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4824 E BROOKSTOWN DR
BATON ROUGE, LA
70805-3823
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1952424194 — HEAVENLY HAVEN
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4824 E BROOKSTOWN DR
BATON ROUGE, LA
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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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