# BLUE HAYVEN IN-HOME HEALTH CARE

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

## Provider details

- **NPI number:** 1922335926
- **Authorized official:** MRS. NICOLE BROCK-WILLIAMS (OWNER)
- **Authorized official phone:** (314) 395-6121

## Contact information

- **Practice address:** 11553 WITHERSFIELD DR, SAINT LOUIS, MO 63138-1152
- **Practice address phone:** (314) 395-6121
- **Practice address fax:** (314) 395-6121
- **Mailing address:** 11553 WITHERSFIELD DR, SAINT LOUIS, MO 63138-1152
- **Mailing address phone:** (314) 395-6121
- **Mailing address fax:** (314) 395-6121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/11/2009
- **Last updated:** 11/11/2009