Provider Demographics
NPI:1104691583
Name:HARBOR HAVEN LLC
Entity type:Organization
Organization Name:HARBOR HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-659-8385
Mailing Address - Street 1:819 COUNTY ROAD 34
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35962-3334
Mailing Address - Country:US
Mailing Address - Phone:256-659-8385
Mailing Address - Fax:
Practice Address - Street 1:819 COUNTY ROAD 34
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3334
Practice Address - Country:US
Practice Address - Phone:256-659-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty