Healthcare Provider Details

I. General information

NPI: 1770988685
Provider Name (Legal Business Name): MY SAFE HAVEN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date: 05/04/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

566 W EXPRESSWAY 83 SUITE D
SULLIVAN CITY TX
78595
US

IV. Provider business mailing address

566 W EXPRESSWAY 83 SUITE D
SULLIVAN CITY TX
78595
US

V. Phone/Fax

Practice location:
  • Phone: 956-485-6464
  • Fax: 956-485-6202
Mailing address:
  • Phone: 956-485-6464
  • Fax: 956-485-6202

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ALVARO PENA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 956-485-6464