MEDICARE: DREAM HAVEN GROUPHOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1447126420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM HAVEN GROUPHOME LLC

Provider Business Mailing Address
First Line	:	419 SE FALLON DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-2634
Country	:	US
Telephone Number	:	954-548-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 SE FALLON DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-2634
Country	:	US
Telephone Number	:	954-548-7602
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROCHNY JULES
Credential	:
Telephone Number	:	954-548-7602

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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