Provider Demographics
NPI:1760203962
Name:ASPIRE HAVEN GROUP HOMES LLC
Entity type:Organization
Organization Name:ASPIRE HAVEN GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-905-2521
Mailing Address - Street 1:9541 103RD ST APT 1120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-0336
Mailing Address - Country:US
Mailing Address - Phone:770-905-2521
Mailing Address - Fax:
Practice Address - Street 1:2093 AMBERLY DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-3698
Practice Address - Country:US
Practice Address - Phone:770-905-2521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services