MEDICARE: COMFORT HAVEN HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1194669556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT HAVEN HOME CARE LLC

Provider Business Mailing Address
First Line	:	12401 ROSE HAVEN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-6061
Country	:	US
Telephone Number	:	317-666-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 ROSE HAVEN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-6061
Country	:	US
Telephone Number	:	317-666-0029
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAYCHELL RAY
Credential	:	RN
Telephone Number	:	317-666-0029

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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