MEDICARE: THE PHARE 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	372600000X	Adult Companion
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1366369688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PHARE HAVEN LLC

Provider Business Mailing Address
First Line	:	7451 ROBERTS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3460
Country	:	US
Telephone Number	:	904-480-8470
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 ROBERTS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3460
Country	:	US
Telephone Number	:	904-480-8470
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. IRIS JENKINS-BROWN
Credential	:
Telephone Number	:	904-480-8470

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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Directions to “THE PHARE HAVEN LLC ” Practice Location

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