MEDICARE: HAVEN OF HOPE GROUP HOME

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1700734639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN OF HOPE GROUP HOME

Provider Business Mailing Address
First Line	:	621 TABASCO TRL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4213
Country	:	US
Telephone Number	:	501-940-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 TABASCO TRL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4213
Country	:	US
Telephone Number	:	501-940-1383
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANA N/A WHITFIELD
Credential	:
Telephone Number	:	501-940-1383

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “HAVEN OF HOPE GROUP HOME ” Practice Location

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