Healthcare Provider Details

I. General information

NPI: 1609722164
Provider Name (Legal Business Name): THE HAVEN HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 JAMES MADISON LN
GLENN DALE MD
20769-9172
US

IV. Provider business mailing address

12221 JAMES MADISON LN
GLENN DALE MD
20769-9172
US

V. Phone/Fax

Practice location:
  • Phone: 301-256-7258
  • Fax:
Mailing address:
  • Phone: 301-256-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PHILOMINA OWUSU-ANSAH
Title or Position: CEO
Credential:
Phone: 301-256-7258