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Organization
HEALTHY HAVEN GROUP HOME LLC
Active
Organization
HEALTHY HAVEN GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASHANNAH LEWIS (OWNER/CEO)
(813) 403-8296
Entity
Organization
Contact information
Practice address
11350 66TH ST STE 104, LARGO, FL 33773-5524
(813) 403-8296
Mailing address
8761 N 56TH ST UNIT 292024, TAMPA, FL 33687-9180
(813) 403-8296
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
320700000X
Physical Disabilities Residential Treatment Facility
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
Other
Enumeration date
02/04/2021
Last updated
02/04/2021
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