=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538026554
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VELA HAVEN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2026
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3705 ELDBRIDGE TER
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716-7314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-940-8117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5557 BALTIMORE AVE STE 500-925
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20781-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-940-8117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ FOUNDER
-----------------------------------------------------
Name | KIMBERLY MARIE
-----------------------------------------------------
Credential | CD, CSC, CBS, MSC.
-----------------------------------------------------
Telephone | 754-224-6139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------