Provider Demographics
NPI:1841645082
Name:HAVENCREST ALF LLC
Entity type:Organization
Organization Name:HAVENCREST ALF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-683-3945
Mailing Address - Street 1:2880 NW 25TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3698
Mailing Address - Country:US
Mailing Address - Phone:954-683-3945
Mailing Address - Fax:
Practice Address - Street 1:2880 NW 25TH WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3698
Practice Address - Country:US
Practice Address - Phone:954-683-3945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVENCREST ALF OF PALM BEACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility