HEIDIS HAVEN LLC (NPI# 1073759890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073759890 |
| Entity Type | Organization |
| Organization Name | HEIDIS HAVEN LLC |
| Other Organization Name | HEIDIS HAVEN - LADY LAKE |
| Practice Address |
39106 Grays Airport Rd Lady Lake FL 32159-4004 |
| Mailing Address |
51 Barlow Fields Dr Hayesville NC 28904-9485 |
| Practice Telephone | 3527873034 |
| Practice Fax Number | 3527875979 |
| Mailing Telephone | 8283894915 |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2016-09-14 |
| Authorized Official Name | MR. DONALD WILLIAM JOHNSON (OWNER/ ADMINISTRATOR) |
| Authorized Official Telephone | 8283894915 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL10397 | FL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Heidis Haven - Lady Lake | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609204833 | Heidis Haven LLC | Assisted Living Facility | 1205 Bonaire Dr, Leesburg, FL 34748-5707 | 2013-10-25 |
| 1255769840 | Heidis Haven LLC | Assisted Living Facility | 1215 La Salida Way, Leesburg, FL 34748-8272 | 2013-10-17 |
| 1750719340 | Heidis Haven LLC | Assisted Living Facility | 36321 Grays Airport Rd, Fruitland Park, FL 34731-5418 | 2013-10-17 |
| Street Address |
39106 GRAYS AIRPORT RD |
| City | LADY LAKE |
| State | FL |
| Zip Code | 32159-4004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447872601 | Lubis Enterprise LLC | Assisted Living Facility | 39106 Grays Airport Rd, Lady Lake, FL 32159-4004 | 2020-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306451216 | Lindsey Porubcan | Physician Assistant | 990 South Us Highway 441/27, Lady Lake, FL 32159 | 2020-09-09 |
| 1073134979 | Michael Robert Frates | Dietitian, Registered | 900 Cr 466, Lady Lake, FL 32159 | 2020-05-01 |
| 1346800364 | Barbara Conrad | Social Worker | 906 Orchid Street, Lady Lake, FL 32159 | 2019-06-20 |
| 1962977165 | Curelogics Wound Care and Hyperbaric LLC | Registered Nurse | 809 County Road 466, Unit C-201, Lady Lake, FL 32159 | 2018-10-04 |
| 1346736907 | Caroline Butler | Physician Assistant | 805 E. Cr 466, Lady Lake, FL 32159 | 2018-07-06 |
| 1033609607 | Cyrus Immanuel Macalisang Doroy | Physical Therapist | 6340 County Rd 466, Suite 733, Lady Lake, FL 32159 | 2018-05-18 |
| 1962999680 | Sharma Institute of Pain Medicine | Physical Medicine & Rehabilitation | 1501 Us Hwy 441, Villages, FL 32159 | 2018-04-18 |
| 1538683198 | Cathleen Laurel Civiello | Psychologist | 929 H. Hwy 441, Suite 404, Lady Lake, FL 32159 | 2017-07-26 |
| 1649709015 | Adria Young | Optometrist | 801 Cr 466, Suite 102 Sunset Plaza, Lady Lake, FL 32159 | 2017-06-08 |
| 1891222527 | Center for Hope and Healing, LLC | Social Worker | 804 Hwy 466, Lady Lake, FL 32159 | 2017-05-12 |
| Find all providers in zip 32159 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780221077 | Village Veranda At Lady Lake, LLC | Assisted Living Facility | 955 S Us Highway 441, Lady Lake, FL 32159-5208 | 2019-12-05 |
| 1306148663 | Wryp Alf LLC | Assisted Living Facility | 930 County Road 466, Lady Lake, FL 32159 | 2010-11-18 |
| 1043416571 | Springs of Lady Lake Alf, LLC | Assisted Living Facility | 620 Griffin Ave, Lady Lake, FL 32159-8103 | 2007-06-22 |
| 1447872601 | Lubis Enterprise LLC | Assisted Living Facility | 39106 Grays Airport Rd, Lady Lake, FL 32159-4004 | 2020-05-11 |
| 1184260317 | Cht Harborchase Trs Tenant Corp. | Assisted Living Facility | 13517 Ne 86th Dr, Lady Lake, FL 32159-8912 | 2019-11-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.