NPIMap

Organization Active NPI

Heidis Haven LLC

  • Assisted Living Facility
  • Fruitland Park, FL
National Provider Identifier
1750719340
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL11978 Issued in FL
Legal business name
HEIDIS HAVEN LLC
Practice address
36321 Grays Airport Rd
Fruitland Park, FL 34731-5418
Phone
(352) 787-3034
Fax
(352) 787-3034
NPI assigned
Oct 17, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 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/ Administrator
Phone
(352) 787-3034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL11978 FL Primary

Addresses

Primary practice location

36321 Grays Airport Rd
Fruitland Park, FL 34731-5418

Mailing address

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

Other names 1

  • Heidis Haven-Fruitland Park 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.

NPI Registry JSON

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

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381968000000",
    "number": "1750719340",
    "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": "36321 GRAYS AIRPORT RD",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347315418",
            "telephone_number": "352-787-3034",
            "fax_number": "352-787-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEIDIS HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-17",
        "last_updated": "2013-10-17",
        "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": "352-787-3034",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heidis Haven-Fruitland Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitland Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.