MEDICARE: HAVEN OF MEMORABLE EXPERIENCES INC

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	261QC1500X	Community Health Clinic/Center
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1992340822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN OF MEMORABLE EXPERIENCES INC

Provider Business Mailing Address
First Line	:	PO BOX 202061
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77220-2061
Country	:	US
Telephone Number	:	832-715-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5536 TREMPER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4747
Country	:	US
Telephone Number	:	832-715-9100
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/DIRECTOR
Name	:	DEBBIE N GIBSON
Credential	:
Telephone Number	:	713-591-7782

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	03/10/2021

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