Provider Demographics
NPI:1760028724
Name:BLUE HAVEN ADULT CENTER
Entity Type:Organization
Organization Name:BLUE HAVEN ADULT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:251-455-7037
Mailing Address - Street 1:1725 LOTT RD
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3845
Mailing Address - Country:US
Mailing Address - Phone:251-455-7037
Mailing Address - Fax:
Practice Address - Street 1:1725 LOTT RD
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-3845
Practice Address - Country:US
Practice Address - Phone:251-455-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care