Provider Demographics
NPI:1508605221
Name:NEW HAVEN ASSISTED LIVING INC
Entity type:Organization
Organization Name:NEW HAVEN ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-307-7719
Mailing Address - Street 1:4364 LITTLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-7918
Mailing Address - Country:US
Mailing Address - Phone:616-307-7719
Mailing Address - Fax:
Practice Address - Street 1:231 4TH ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-5024
Practice Address - Country:US
Practice Address - Phone:616-307-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency