Provider Demographics
NPI:1013270990
Name:HAVEN'S HOME HEALTH LLC
Entity Type:Organization
Organization Name:HAVEN'S HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALLIED HEALTH INSTRUCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREATHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANBACK
Authorized Official - Suffix:
Authorized Official - Credentials:RMA, BHCM, MHCB
Authorized Official - Phone:1888-959-1468
Mailing Address - Street 1:492 BAVARIAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3106
Mailing Address - Country:US
Mailing Address - Phone:513-649-1941
Mailing Address - Fax:
Practice Address - Street 1:492 BAVARIAN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-3106
Practice Address - Country:US
Practice Address - Phone:888-959-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health