MEDICARE: A HAVEN OF 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	:	1255077525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A HAVEN OF CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 242182
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28224-2182
Country	:	US
Telephone Number	:	704-649-2441
Fax Number	:

Provider Business Practice Location Address
First Line	:	6047 TYVOLA GLEN CIR STE 244
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-6436
Country	:	US
Telephone Number	:	704-649-2441
Fax Number	:

Authorized Official
Title or Position	:	AGENCY OPERATOR
Name	:	JASMINE FREDERICK
Credential	:
Telephone Number	:	704-649-2441

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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