Provider Demographics
NPI:1376165076
Name:HAVEN ADULT FOSTER CARE LTD
Entity Type:Organization
Organization Name:HAVEN ADULT FOSTER CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRYDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-784-8890
Mailing Address - Street 1:73600 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-4749
Mailing Address - Country:US
Mailing Address - Phone:586-784-8890
Mailing Address - Fax:586-784-8894
Practice Address - Street 1:73600 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-4749
Practice Address - Country:US
Practice Address - Phone:586-784-8890
Practice Address - Fax:586-784-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home