Healthcare Provider Details

I. General information

NPI: 1134954175
Provider Name (Legal Business Name): CARE HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 W PIONEER PKWY
ARLINGTON TX
76013-6230
US

IV. Provider business mailing address

1506 W PIONEER PKWY
ARLINGTON TX
76013-6230
US

V. Phone/Fax

Practice location:
  • Phone: 817-704-0772
  • Fax: 817-704-0708
Mailing address:
  • Phone: 817-704-0772
  • Fax: 817-704-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PILIRA MWASI
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 817-704-0772