Provider Demographics
NPI:1780321034
Name:DAILY HAVEN INC.
Entity type:Organization
Organization Name:DAILY HAVEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:SUZANN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:MAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-761-8889
Mailing Address - Street 1:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1084
Mailing Address - Country:US
Mailing Address - Phone:770-761-8889
Mailing Address - Fax:770-761-0855
Practice Address - Street 1:1105 N MAIN ST NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-4352
Practice Address - Country:US
Practice Address - Phone:770-761-8889
Practice Address - Fax:770-761-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000669446AMedicaid
GA000669446BMedicaid