MEDICARE: KAE'S HAVEN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1144174236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAE'S HAVEN LLC

Provider Business Mailing Address
First Line	:	18959 DALLAS PKWY APT 2011
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3185
Country	:	US
Telephone Number	:	708-205-8533
Fax Number	:

Provider Business Practice Location Address
First Line	:	18959 DALLAS PKWY APT 2011
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3185
Country	:	US
Telephone Number	:	708-205-8533
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAKESHA WOOTEN
Credential	:
Telephone Number	:	708-205-8533

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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