1447253661 NPI number — HAVEN HOMES, INC.

Table of content: (NPI 1447253661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447253661 NPI number — HAVEN HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN HOMES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447253661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4848 GATEWAY BLVD
Provider Second Line Business Mailing Address:
MAPLE PLAIN
Provider Business Mailing Address City Name:
MAPLE PLAIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-292-2300
Provider Business Mailing Address Fax Number:
763-479-3656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 WYMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE PLAIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55359-9639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-479-1993
Provider Business Practice Location Address Fax Number:
763-479-3656
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STADTHERR
Authorized Official First Name:
SEELOCHANI
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
952-855-5041

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  325307 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064742000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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