Healthcare Provider Details

I. General information

NPI: 1215747654
Provider Name (Legal Business Name): HAVENSLOVE&JOY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR STE 4908
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

1317 EDGEWATER DR STE 4908
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 407-953-7859
  • Fax:
Mailing address:
  • Phone: 407-953-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CHEVELLE TEAGUE
Title or Position: OWNER
Credential:
Phone: 407-953-7859