Provider Demographics
NPI:1346409620
Name:OAK HAVEN ADULT FOSTER CARE
Entity Type:Organization
Organization Name:OAK HAVEN ADULT FOSTER CARE
Other - Org Name:BUNKER HILL ADULT FOSTER CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CAREGIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:218-927-6624
Mailing Address - Street 1:43370 STATE HIGHWAY 210
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-5097
Mailing Address - Country:US
Mailing Address - Phone:218-927-6624
Mailing Address - Fax:
Practice Address - Street 1:43370 STATE HIGHWAY 210
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-5097
Practice Address - Country:US
Practice Address - Phone:218-927-6624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1018758-3-AFC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility