Provider Demographics
NPI:1467284760
Name:DS HEAVENLY HAVEN
Entity type:Organization
Organization Name:DS HEAVENLY HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SEMANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-627-7718
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-0606
Mailing Address - Country:US
Mailing Address - Phone:989-627-7718
Mailing Address - Fax:
Practice Address - Street 1:2120 HEAVENLY HAVEN DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9761
Practice Address - Country:US
Practice Address - Phone:989-627-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty