Provider Demographics
NPI:1720225709
Name:HAVENNHILLS
Entity Type:Organization
Organization Name:HAVENNHILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-738-3053
Mailing Address - Street 1:495 ZION HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6304
Mailing Address - Country:US
Mailing Address - Phone:828-738-3053
Mailing Address - Fax:828-738-0350
Practice Address - Street 1:2391 NC HIGHWAY 226
Practice Address - Street 2:
Practice Address - City:BOSTIC
Practice Address - State:NC
Practice Address - Zip Code:28018-7661
Practice Address - Country:US
Practice Address - Phone:828-245-2998
Practice Address - Fax:828-248-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL081041311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHAL081041OtherLICENSE