Provider Demographics
NPI:1053003889
Name:MAGGIES HAVEN, LLC
Entity type:Organization
Organization Name:MAGGIES HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREEN-NORFLEE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:352-602-1175
Mailing Address - Street 1:1707 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3111
Mailing Address - Country:US
Mailing Address - Phone:352-602-1175
Mailing Address - Fax:
Practice Address - Street 1:636 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3123
Practice Address - Country:US
Practice Address - Phone:352-602-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117291100Medicaid