Provider Demographics
NPI:1275655599
Name:HEATHERS HAVEN INC
Entity Type:Organization
Organization Name:HEATHERS HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-273-2689
Mailing Address - Street 1:1039 E HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1017
Mailing Address - Country:US
Mailing Address - Phone:269-273-2689
Mailing Address - Fax:269-273-2689
Practice Address - Street 1:1039 E HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1017
Practice Address - Country:US
Practice Address - Phone:269-273-2689
Practice Address - Fax:269-273-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health