Provider Demographics
NPI:1841000346
Name:ANGEL HAVEN BY THE CREEK LLC
Entity type:Organization
Organization Name:ANGEL HAVEN BY THE CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFH PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:II
Authorized Official - Credentials:RN
Authorized Official - Phone:253-279-7919
Mailing Address - Street 1:20706 61ST ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6137
Mailing Address - Country:US
Mailing Address - Phone:253-279-7919
Mailing Address - Fax:
Practice Address - Street 1:813 26TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7706
Practice Address - Country:US
Practice Address - Phone:253-279-7919
Practice Address - Fax:253-737-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty