Organization
CARE HAVEN LLC
Active
Other names
Care Haven
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIA V DERVISEVIC RN BSN (CO-OWNER)
(727) 637-8615
Entity
Organization
Contact information
Practice address
1746 30TH LN SW FL 33774, LARGO, FL 33774-1415
(727) 637-8615
(813) 925-6184
Mailing address
762 COLONY LN, LARGO, FL 33770-2963
(727) 637-8615
(813) 925-6184
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008423100
—
FL
Enumeration date
01/28/2022
Last updated
01/28/2022
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