Healthcare Provider Details

I. General information

NPI: 1104764604
Provider Name (Legal Business Name): HAVENCARE HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CAPEN ST
HARTFORD CT
06112-1903
US

IV. Provider business mailing address

260 CAPEN ST
HARTFORD CT
06112-1903
US

V. Phone/Fax

Practice location:
  • Phone: 860-999-5542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: JOHANA LUISA DIAZ
Title or Position: CEO/OWNER
Credential:
Phone: 860-999-5542