Active NPI
Heidis Haven LLC
Doing business as Heidis Haven - Lady Lake
- Assisted Living Facility
- Lady Lake, FL
National Provider Identifier
1073759890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- AL10397
- Legal business name
- HEIDIS HAVEN LLC
- Doing business as
- Heidis Haven - Lady Lake
- Practice address
- 39106 Grays Airport Rd
Lady Lake, FL 32159-4004 - Phone
- (352) 787-3034
- Fax
- (352) 787-5979
- NPI assigned
- Dec 29, 2008
- Last updated
- Sep 14, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Donald William Johnson
- Title
- Owner/ Administrator
- Phone
- (828) 389-4915
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL10397 | FL | Primary |
Addresses
Primary practice location
39106 Grays Airport Rd
Lady Lake, FL 32159-4004
Mailing address
51 Barlow Fields Dr
Hayesville, NC 28904-9485
Phone (828) 389-4915
Other names 1
- Heidis Haven - Lady Lake
National Provider Directory
National Provider Directory- Tax ID family
- Heidis Haven LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Heidis Haven-Fruitland Park
- Assisted Living Facility
- Fruitland Park, FL
- NPI 1750719340
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Podiatrist
- Leesburg, FL
- NPI 1538256334
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230508800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1473811200000",
"number": "1073759890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 BARLOW FIELDS DR",
"city": "HAYESVILLE",
"state": "NC",
"postal_code": "289049485",
"telephone_number": "828-389-4915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39106 GRAYS AIRPORT RD",
"city": "LADY LAKE",
"state": "FL",
"postal_code": "321594004",
"telephone_number": "352-787-3034",
"fax_number": "352-787-5979"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEIDIS HAVEN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-12-29",
"last_updated": "2016-09-14",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "DONALD",
"authorized_official_middle_name": "WILLIAM",
"authorized_official_title_or_position": "OWNER/ ADMINISTRATOR",
"authorized_official_telephone_number": "828-389-4915",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "FL",
"license": "AL10397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Heidis Haven - Lady Lake",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lady Lake, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.