MEDICARE: HAVEN'S PEDIATRIC 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	3747P1801X	Personal Care Attendant
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1720604762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN'S PEDIATRIC LLC

Provider Business Mailing Address
First Line	:	2111 CASTLE GARDENS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-1739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 CASTLE GARDENS LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-1739
Country	:	US
Telephone Number	:	832-406-5720
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	MRS. RFANYU DAISY TALLA AYUK MANYANG
Credential	:
Telephone Number	:	832-406-5720

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	04/15/2026

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