Provider Demographics
NPI:1730704487
Name:HEAVEN'S HAVEN LIVING FACILITY
Entity type:Organization
Organization Name:HEAVEN'S HAVEN LIVING FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CIELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-509-8641
Mailing Address - Street 1:6300 GRELOT RD # STG1235
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3602
Mailing Address - Country:US
Mailing Address - Phone:251-509-8641
Mailing Address - Fax:
Practice Address - Street 1:6300 GRELOT RD # STG1235
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3602
Practice Address - Country:US
Practice Address - Phone:251-509-8641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care