Provider Demographics
NPI:1558168187
Name:HAVEN PLACE 21 LLC
Entity type:Organization
Organization Name:HAVEN PLACE 21 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWMER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:ANASTASIA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-825-6950
Mailing Address - Street 1:743 PEARL CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4223
Mailing Address - Country:US
Mailing Address - Phone:813-825-6950
Mailing Address - Fax:
Practice Address - Street 1:743 PEARL CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4223
Practice Address - Country:US
Practice Address - Phone:813-825-6950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility