Provider Demographics
NPI:1558882118
Name:HAVEN HOME HEALTH AGENCY FOR KIDS, LLC D/B/A HAVEN HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:HAVEN HOME HEALTH AGENCY FOR KIDS, LLC D/B/A HAVEN HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AGENCY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:K
Authorized Official - Last Name:PLUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:314-802-4999
Mailing Address - Street 1:475 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:475 FALCON DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2107
Practice Address - Country:US
Practice Address - Phone:314-802-4999
Practice Address - Fax:314-802-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018072251B00000X, 251E00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care