Provider Demographics
NPI:1972646693
Name:HAVEN MANOR, INC.
Entity Type:Organization
Organization Name:HAVEN MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAINING PROGRAM SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LA
Authorized Official - Phone:402-434-2680
Mailing Address - Street 1:PO BOX 6125
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0125
Mailing Address - Country:US
Mailing Address - Phone:402-434-2680
Mailing Address - Fax:402-434-2683
Practice Address - Street 1:4848 S 48TH ST
Practice Address - Street 2:STE. 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1290
Practice Address - Country:US
Practice Address - Phone:402-434-2680
Practice Address - Fax:402-434-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6681603310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility