Provider Demographics
NPI:1972674158
Name:HEATHER ANN WOOD
Entity Type:Organization
Organization Name:HEATHER ANN WOOD
Other - Org Name:HEATHERS HAVEN HHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-273-2689
Mailing Address - Street 1:1039 E HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1017
Mailing Address - Country:US
Mailing Address - Phone:269-273-2689
Mailing Address - Fax:
Practice Address - Street 1:1039 E HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1017
Practice Address - Country:US
Practice Address - Phone:269-273-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health