Provider Demographics
NPI:1184372500
Name:BLESSED HAVEN
Entity type:Organization
Organization Name:BLESSED HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLEATRICE
Authorized Official - Middle Name:BONNIE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-571-9114
Mailing Address - Street 1:1025 PLYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2537
Mailing Address - Country:US
Mailing Address - Phone:919-571-9114
Mailing Address - Fax:
Practice Address - Street 1:1025 PLYMOUTH DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2537
Practice Address - Country:US
Practice Address - Phone:919-571-9114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home