Provider Demographics
NPI:1104364199
Name:HAVEN HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:HAVEN HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY HOME BASED SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-245-9693
Mailing Address - Street 1:1515 WARSON RD
Mailing Address - Street 2:111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:800-245-9693
Mailing Address - Fax:
Practice Address - Street 1:1515 N WARSON RD
Practice Address - Street 2:111
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1111
Practice Address - Country:US
Practice Address - Phone:800-245-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health