Healthcare Provider Details

I. General information

NPI: 1356052690
Provider Name (Legal Business Name): HAVEN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 TRINITY PEAK AVE STE 260
LAS VEGAS NV
89128-9026
US

IV. Provider business mailing address

7501 TRINITY PEAK AVE STE 260
LAS VEGAS NV
89128-9026
US

V. Phone/Fax

Practice location:
  • Phone: 702-882-7736
  • Fax:
Mailing address:
  • Phone: 702-882-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FRANKLIN FONTILLAS
Title or Position: MEMBER
Credential:
Phone: 469-983-0099