Provider Demographics
NPI:1164271284
Name:HEALING HAVEN HOMES AT MESQUITE LLC
Entity type:Organization
Organization Name:HEALING HAVEN HOMES AT MESQUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOI
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:703-554-7829
Mailing Address - Street 1:1025 CAVERN DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4418
Mailing Address - Country:US
Mailing Address - Phone:703-554-7829
Mailing Address - Fax:469-397-0779
Practice Address - Street 1:1025 CAVERN DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4418
Practice Address - Country:US
Practice Address - Phone:703-554-7829
Practice Address - Fax:469-397-0779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALING HAVEN HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility