MEDICARE: JUNE HAVEN PCH 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	:	1407788623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNE HAVEN PCH LLC

Provider Business Mailing Address
First Line	:	1169 CROOKED CREEK RD
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-6133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1169 CROOKED CREEK RD
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-6133
Country	:	US
Telephone Number	:	770-343-0907
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEISHA ARCHER
Credential	:
Telephone Number	:	770-343-0907

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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