Healthcare Provider Details

I. General information

NPI: 1124966478
Provider Name (Legal Business Name): HAVEN LEGACY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 BELLFLOWER DR
GLENN HEIGHTS TX
75154-8788
US

IV. Provider business mailing address

1913 BELLFLOWER DR
GLENN HEIGHTS TX
75154-8788
US

V. Phone/Fax

Practice location:
  • Phone: 817-726-6833
  • Fax:
Mailing address:
  • Phone: 817-726-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRITTANY WASHINGTON
Title or Position: MANAGING MEMBER
Credential:
Phone: 817-726-6833