Provider Demographics
NPI:1730563693
Name:HAVEN ADULT DAY CARE, LLC
Entity type:Organization
Organization Name:HAVEN ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-395-3023
Mailing Address - Street 1:1401 E 4TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3504
Mailing Address - Country:US
Mailing Address - Phone:305-887-0555
Mailing Address - Fax:305-882-1181
Practice Address - Street 1:1401 E 4TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3504
Practice Address - Country:US
Practice Address - Phone:305-887-0555
Practice Address - Fax:305-882-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care