Organization
HAVEN LEE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA AGUDELO ADMINISTRATOR (ADMINISTRATOR)
(248) 885-5885
Entity
Organization
Contact information
Practice address
760 WATTLES RD, BLOOMFIELD HILLS, MI 48304-3279
(248) 550-6544
Mailing address
760 WATTLES RD, BLOOMFIELD HILLS, MI 48304-3279
(248) 550-6544
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS630385908
ADULT FOSTER CARE LICENSE
MI
Enumeration date
03/17/2020
Last updated
03/17/2020
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