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General NPI Number Information
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NPI Number | 1295733152
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Entity Type | Organization
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Legal Business Name | HAVEN HOME HEALTH, LLC
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 5601 EXECUTIVE DR STE 250A
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City | IRVING
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State | TX
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Zip | 75038-2508
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Country | US
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Telephone | 972-644-3000
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Fax | 972-644-3040
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Provider Business Mailing Address
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Address Line | 5601 EXECUTIVE DR STE 250
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City | IRVING
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State | TX
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Zip | 75038-2508
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Country | US
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Telephone | 972-677-3499
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JONATHAN GEORGE FUNSTON
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Credential |
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Telephone | 706-877-0838
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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 | 008425
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License Number State | TX
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