NPIMap

Organization Active NPI

Heidis Haven LLC

  • Assisted Living Facility
  • Leesburg, FL
National Provider Identifier
1609204833
Registry record updated Oct 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL11255 Issued in FL
Legal business name
HEIDIS HAVEN LLC
Practice address
1205 Bonaire Dr
Leesburg, FL 34748-5707
Phone
(352) 787-3034
Fax
(352) 787-5979
NPI assigned
Oct 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2013

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/President
Phone
(352) 787-3034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL11255 FL Primary

Addresses

Primary practice location

1205 Bonaire Dr
Leesburg, FL 34748-5707

Mailing address

1215 La Salida Way
Leesburg, FL 34748-8272
Phone (352) 787-3034

Other names 1

  • Heidis Haven-Bonaire Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heidis Haven LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382659200000",
    "number": "1609204833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 LA SALIDA WAY",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347488272",
            "telephone_number": "352-787-3034",
            "fax_number": "352-787-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 BONAIRE DR",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485707",
            "telephone_number": "352-787-3034",
            "fax_number": "352-787-5979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEIDIS HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2013-10-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "352-787-3034",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heidis Haven-Bonaire",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; 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.