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General NPI Number Information
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NPI Number | 1396568663
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Entity Type | Organization
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Legal Business Name | A HAVEN OF HOPE RESIDENTIAL SERVICES, INC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 700 AGORA CT
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City | HASLET
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State | TX
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Zip | 76052-5142
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Country | US
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Telephone | 425-830-2151
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Fax |
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Provider Business Mailing Address
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Address Line | 700 AGORA CT
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City | HASLET
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State | TX
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Zip | 76052-5142
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Country | US
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Telephone | 425-830-2151
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELIZABETH TANKSLEY
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Credential |
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Telephone | 425-830-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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