Healthcare Provider Details

I. General information

NPI: 1710899638
Provider Name (Legal Business Name): HARBOR & HAVEN HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 POPLAR MANOR AVE
FREDERICKSBURG VA
22406-4158
US

IV. Provider business mailing address

1520 BELLE VIEW BLVD PMB 5517
ALEXANDRIA VA
22307-6530
US

V. Phone/Fax

Practice location:
  • Phone: 202-834-7910
  • Fax:
Mailing address:
  • Phone: 202-834-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKEISHA T BRADSHAW-MCINTOSH
Title or Position: MANAGING MEMBER
Credential:
Phone: 202-834-7910