# HEALTHY HAVEN GROUP HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275125973
- **Authorized official:** HASHANNAH LEWIS (OWNER/CEO)
- **Authorized official phone:** (813) 403-8296

## Contact information

- **Practice address:** 11350 66TH ST STE 104, LARGO, FL 33773-5524
- **Practice address phone:** (813) 403-8296
- **Mailing address:** 8761 N 56TH ST UNIT 292024, TAMPA, FL 33687-9180
- **Mailing address phone:** (813) 403-8296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 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