Provider Demographics
NPI:1861447849
Name:HAVEN HEALTH OF LOUISIANA INC
Entity Type:Organization
Organization Name:HAVEN HEALTH OF LOUISIANA INC
Other - Org Name:HAVEN HEALTH AND HOSPICE OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-426-7500
Mailing Address - Street 1:753 ROBERT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-649-6001
Mailing Address - Fax:985-649-6006
Practice Address - Street 1:753 ROBERT BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-649-6001
Practice Address - Fax:985-649-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA167251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191612OtherMEDICARE PROVIDER NUMBER
LA191612OtherMEDICARE PROVIDER NUMBER
191612Medicare Oscar/Certification