Provider Demographics
NPI:1336401645
Name:EDEN HAVEN LLC
Entity Type:Organization
Organization Name:EDEN HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:SIBONGINKOSI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-806-5456
Mailing Address - Street 1:1339 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5101
Mailing Address - Country:US
Mailing Address - Phone:269-806-5459
Mailing Address - Fax:
Practice Address - Street 1:317 N SAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4040
Practice Address - Country:US
Practice Address - Phone:269-806-5459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS390314539253J00000X
MI253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency