MEDICARE: HEARTFUL HAVEN COMPANION CARE 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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1447195169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTFUL HAVEN COMPANION CARE LLC

Provider Business Mailing Address
First Line	:	39712 RIVER RD
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-7192
Country	:	US
Telephone Number	:	352-652-2841
Fax Number	:

Provider Business Practice Location Address
First Line	:	39712 RIVER RD
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-7192
Country	:	US
Telephone Number	:	352-652-2841
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRISCILLA CONTRERAS
Credential	:
Telephone Number	:	352-652-2841

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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