Provider Demographics
NPI:1861677171
Name:FLOR HAVEN HOME LLC
Entity Type:Organization
Organization Name:FLOR HAVEN HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:GAYE
Authorized Official - Last Name:OVERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-542-2598
Mailing Address - Street 1:433 S 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2519
Mailing Address - Country:US
Mailing Address - Phone:406-542-2598
Mailing Address - Fax:
Practice Address - Street 1:433 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2519
Practice Address - Country:US
Practice Address - Phone:406-542-2598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11096310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility