Provider Demographics
NPI:1982112181
Name:HAVEN HOME HEALTH AGENCY FOR KIDS, LLC
Entity Type:Organization
Organization Name:HAVEN HOME HEALTH AGENCY FOR KIDS, LLC
Other - Org Name:HAVEN HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:K
Authorized Official - Last Name:PLUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:314-882-9747
Mailing Address - Street 1:475 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2107
Mailing Address - Country:US
Mailing Address - Phone:314-882-9747
Mailing Address - Fax:
Practice Address - Street 1:475 FALCON DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2107
Practice Address - Country:US
Practice Address - Phone:314-802-4999
Practice Address - Fax:314-802-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care