Healthcare Provider Details

I. General information

NPI: 1891659231
Provider Name (Legal Business Name): HEALTH HAVEN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 BAYLOR CIR
MCDONOUGH GA
30253-6164
US

IV. Provider business mailing address

3208 BAYLOR CIR
MCDONOUGH GA
30253-6164
US

V. Phone/Fax

Practice location:
  • Phone: 404-421-2100
  • Fax:
Mailing address:
  • Phone: 404-421-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. FOLASHADE MEDUTENI
Title or Position: OWNER/DIRECTOR
Credential: RN,BSN
Phone: 404-421-2100