MEDICARE: HAVEN HOME HEALTH, 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	251E00000X	Home Health Agency	008425	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45D1010398	OTHER	TX	CLIA LAB WAIVER

General Provider Information

NPI Number	:	1295733152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	5601 EXECUTIVE DR STE 250
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2803
Country	:	US
Telephone Number	:	972-677-3499
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 EXECUTIVE DR STE 250A
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2508
Country	:	US
Telephone Number	:	972-644-3000
Fax Number	:	972-644-3040

Authorized Official
Title or Position	:	CFO
Name	:	JAMES DOUTHITT
Credential	:
Telephone Number	:	940-600-5140

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	03/11/2026

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Directions to “HAVEN HOME HEALTH, LLC ” Practice Location

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