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General NPI Number Information
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NPI Number | 1194390336
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Entity Type | Organization
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Legal Business Name | HAVEN HOME CARE LLC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 64 E BROADWAY RD STE 200
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City | TEMPE
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State | AZ
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Zip | 85282-1377
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Country | US
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Telephone | 480-283-5503
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Fax |
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Provider Business Mailing Address
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Address Line | 2969 N OREGON ST UNIT 10
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City | CHANDLER
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State | AZ
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Zip | 85225-7757
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Country | US
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Telephone | 480-283-5503
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KAELYN SOLOMON
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Credential |
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Telephone | 480-283-5503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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