Provider Demographics
NPI:1225469828
Name:HILLHAVEN LLC
Entity Type:Organization
Organization Name:HILLHAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-387-9119
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0179
Mailing Address - Country:US
Mailing Address - Phone:218-387-9119
Mailing Address - Fax:218-387-9561
Practice Address - Street 1:1683 E. HWY 61
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-0179
Practice Address - Country:US
Practice Address - Phone:218-387-9119
Practice Address - Fax:218-387-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1033369-7-AFC253J00000X
MN1059619-1-AFC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency