Provider Demographics
NPI:1235011313
Name:LILLY HAVEN CARE SERVICES LLC
Entity type:Organization
Organization Name:LILLY HAVEN CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMISO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIPURIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:162-927-8075
Mailing Address - Street 1:420 ELYSIAN FIELDS RD APT E4
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4267
Mailing Address - Country:US
Mailing Address - Phone:162-927-8075
Mailing Address - Fax:
Practice Address - Street 1:420 ELYSIAN FIELDS RD APT E4
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4267
Practice Address - Country:US
Practice Address - Phone:162-927-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services