MEDICARE: HALO HAVENS RESIDENTIAL 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1396672515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALO HAVENS RESIDENTIAL LLC

Provider Business Mailing Address
First Line	:	9027 TIBBLE CREEK WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-6670
Country	:	US
Telephone Number	:	704-920-0881
Fax Number	:	704-920-0881

Provider Business Practice Location Address
First Line	:	1515 MOCKINGBIRD LN # 420
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3236
Country	:	US
Telephone Number	:	866-824-7799
Fax Number	:	704-920-0881

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	KIYONNA MORGAN
Credential	:	MORGAN
Telephone Number	:	704-920-0881

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/19/2026

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