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NPI Code Detail

MEDICARE: HEALING HAVEN, LLC

MEDICARE: HEALING HAVEN, LLC
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
1225XP0200XPediatric Occupational Therapist
2235Z00000XSpeech-Language Pathologist
3261QD1600XDevelopmental Disabilities Clinic/Center6301011704MI

General Provider Information

NPI Number : 1790110187
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALING HAVEN, LLC
Provider Business Mailing Address
First Line : 30821 BARRINGTON ST
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1871
Country : US
Telephone Number : 248-965-3916
Fax Number :
Provider Business Practice Location Address
First Line : 30821 BARRINGTON ST
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1871
Country : US
Telephone Number : 734-355-2833
Fax Number : 248-331-9919
Authorized Official
Title or Position : OWNER
Name : MRS. JAMIE ERIN MCGILLIVARY
Credential : MS, LLP, BCBA
Telephone Number : 734-355-2833
Provider Enumeration Date : 09/05/2013
Last Update Date : 08/17/2025

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Directions to “HEALING HAVEN, LLC ” Practice Location

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