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General NPI Number Information
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NPI Number | 1457750358
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Entity Type | Organization
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Legal Business Name | KIYA'S HAVEN ASSISTED LIVING HOME
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 1611 WINDCHIME DR
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City | DALLAS
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State | TX
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Zip | 75224-4816
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Country | US
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Telephone | 214-467-4933
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Fax | 214-467-4933
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Provider Business Mailing Address
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Address Line | 1611 WINDCHIME DR
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City | DALLAS
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State | TX
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Zip | 75224-4816
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Country | US
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Telephone | 214-467-4933
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Fax | 214-467-4933
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEIDRA LYNNETTE WHYETE-BABERS
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Credential |
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Telephone | 214-467-4933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 139938
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License Number State | TX
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