Provider Demographics
NPI:1427357573
Name:HAVILAND OPERATOR, LLC
Entity Type:Organization
Organization Name:HAVILAND OPERATOR, LLC
Other - Org Name:HAVILAND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-440-8345
Mailing Address - Street 1:200 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAVILAND
Mailing Address - State:KS
Mailing Address - Zip Code:67059-9525
Mailing Address - Country:US
Mailing Address - Phone:620-862-5291
Mailing Address - Fax:620-862-5233
Practice Address - Street 1:200 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAVILAND
Practice Address - State:KS
Practice Address - Zip Code:67059-9525
Practice Address - Country:US
Practice Address - Phone:620-862-5291
Practice Address - Fax:620-862-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN049002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200740080AMedicaid