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General NPI Number Information
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NPI Number | 1437710035
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Entity Type | Organization
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Legal Business Name | GREAT HAVEN CARE LLC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 3138 W HAMPTON DR
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City | HOUSTON
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State | TX
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Zip | 77082-3454
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Country | US
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Telephone | 832-876-5908
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Fax |
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Provider Business Mailing Address
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Address Line | 3138 W HAMPTON DR
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City | HOUSTON
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State | TX
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Zip | 77082-3454
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Country | US
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Telephone | 832-876-5908
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Fax |
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Authorized Official
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Title or Position | CEO/PROGRAM MANAGER
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Name | DR. RITA IFY OKAFOR
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Credential | PHARM.D
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Telephone | 832-876-5908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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