Provider Demographics
NPI:1972204261
Name:HAWKINS HAVEN, LLC
Entity Type:Organization
Organization Name:HAWKINS HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-924-9311
Mailing Address - Street 1:7995 NORWICH CT
Mailing Address - Street 2:
Mailing Address - City:PORT TOBACCO
Mailing Address - State:MD
Mailing Address - Zip Code:20677-3428
Mailing Address - Country:US
Mailing Address - Phone:443-924-4954
Mailing Address - Fax:
Practice Address - Street 1:5310 WABASH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-4809
Practice Address - Country:US
Practice Address - Phone:443-924-4954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility