Blue Haven Assisted Living, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11984 Issued in FL

Legal business name

BLUE HAVEN ASSISTED LIVING, INC

Practice address

35525 County Road 473
Leesburg, FL 34788-6161

Phone

(352) 314-0422

Fax

(352) 314-0423

NPI assigned

Mar 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leytonya Hargrove

Title

Administrator

Phone

(352) 409-3585

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1518359363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33409 IRONGATE DR",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347883158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35525 COUNTY ROAD 473",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347886161",
            "telephone_number": "352-314-0422",
            "fax_number": "352-314-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HAVEN ASSISTED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "HARGROVE",
        "authorized_official_first_name": "LEYTONYA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-409-3585"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.