Provider Demographics
NPI:1578318994
Name:BOKA HAVEN INC
Entity Type:Organization
Organization Name:BOKA HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LALD
Authorized Official - Prefix:
Authorized Official - First Name:ETTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKA
Authorized Official - Suffix:
Authorized Official - Credentials:LALD
Authorized Official - Phone:651-350-2840
Mailing Address - Street 1:912 104TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1561
Mailing Address - Country:US
Mailing Address - Phone:651-350-2840
Mailing Address - Fax:
Practice Address - Street 1:5251 386TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056
Practice Address - Country:US
Practice Address - Phone:651-350-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility