Provider Demographics
NPI:1639236888
Name:REST HAVEN HOME HEALTH, INC.
Entity Type:Organization
Organization Name:REST HAVEN HOME HEALTH, INC.
Other - Org Name:FAMILY HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO CHIEF EXECUTIVE OFFICIAL CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-732-4892
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:520 WILLIS AVENUE
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0650
Mailing Address - Country:US
Mailing Address - Phone:985-732-4892
Mailing Address - Fax:985-732-1878
Practice Address - Street 1:520 WILLIS AVENUE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70429-0650
Practice Address - Country:US
Practice Address - Phone:985-732-4892
Practice Address - Fax:985-732-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1400513Medicaid
LA197325Medicare Oscar/Certification