Organization
HEIDIS HAVEN LLC
Active
Other names
Heidis Haven-Fruitland Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD WILLIAM JOHNSON (OWNER/ ADMINISTRATOR)
(352) 787-3034
Entity
Organization
Contact information
Practice address
36321 GRAYS AIRPORT RD, FRUITLAND PARK, FL 34731-5418
(352) 787-3034
(352) 787-3034
Mailing address
1215 LA SALIDA WAY, LEESBURG, FL 34748-8272
(352) 787-3034
(352) 787-5979
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11978
FL
Other
Enumeration date
10/17/2013
Last updated
10/17/2013
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