HEIDIS HAVEN LLC NPI 1073759890

NPI Information

  • NPI: 1073759890
  • Provider Name: HEIDIS HAVEN LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: HEIDIS HAVEN - LADY LAKE
  • Address: 39106 GRAYS AIRPORT RD
    LADY LAKE, FL
    ZIP 32159
  • Phone: (352) 787-3034

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NPI Details

HEIDIS HAVEN LLC is an assisted living facility in Lady Lake, FL. The provider is 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. HEIDIS HAVEN LLC NPI is 1073759890. The provider is registered as an organization entity type.
The provider Is Doing Business As Heidis Haven - Lady Lake.

The provider's business location address is:

39106 GRAYS AIRPORT RD
LADY LAKE, FL
ZIP 32159-004
Phone: (352) 787-3034
Fax: (352) 787-5979

The provider's authorized official is Donald William Johnson .
The authorized official title is Owner/ Administrator and has the following contact phone number (828) 389-4915.

The enumeration date for this NPI number is 12/29/2008 and was last updated on 9/14/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityAL10397FLORIDAYes

What is NPI?

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This page was last updated on: 11/21/2025

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