Healthcare Provider Details

I. General information

NPI: 1619697232
Provider Name (Legal Business Name): HAVEN HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 LANE AVE S
JACKSONVILLE FL
32210-2788
US

IV. Provider business mailing address

4275 HANGING MOSS DR
ORANGE PARK FL
32073-7643
US

V. Phone/Fax

Practice location:
  • Phone: 904-290-2939
  • Fax:
Mailing address:
  • Phone: 904-290-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL RAMOS - RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 904-290-2939