Healthcare Provider Details

I. General information

NPI: 1912997222
Provider Name (Legal Business Name): HAVENCARE NURSING & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RUTHLYNN DR
LONGVIEW TX
75605-5635
US

IV. Provider business mailing address

1400 KATY FLEWELLEN RD UNIT 29
KATY TX
77494-6633
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-2557
  • Fax: 903-757-5709
Mailing address:
  • Phone: 713-806-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number117214
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number117214
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number117214
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number117214
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number117214
License Number StateTX

VIII. Authorized Official

Name: LEROY WILLIAMS
Title or Position: PRESIDENT
Credential:
Phone: 713-806-0027