Provider Demographics
NPI:1134934060
Name:FAMILYCARE HAVEN LLC
Entity type:Organization
Organization Name:FAMILYCARE HAVEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEBR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANIE
Authorized Official - Middle Name:KALA
Authorized Official - Last Name:MURASKI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:607-643-3534
Mailing Address - Street 1:5900 N BURDICK ST STE 204
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9465
Mailing Address - Country:US
Mailing Address - Phone:607-643-3534
Mailing Address - Fax:
Practice Address - Street 1:5900 N BURDICK ST STE 204
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9465
Practice Address - Country:US
Practice Address - Phone:607-643-3534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty