MEDICARE: 1ST HAVEN SUPPORTIVE CARE

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	:	1851259493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST HAVEN SUPPORTIVE CARE

Provider Business Mailing Address
First Line	:	907 VALLEY CREEK PT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-3742
Country	:	US
Telephone Number	:	501-235-0909
Fax Number	:	501-299-3822

Provider Business Practice Location Address
First Line	:	907 VALLEY CREEK PT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-3742
Country	:	US
Telephone Number	:	501-235-0909
Fax Number	:	501-299-3822

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERILYN SWALVE WASSON
Credential	:	LPE
Telephone Number	:	501-425-0472

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	02/12/2026

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Directions to “1ST HAVEN SUPPORTIVE CARE ” Practice Location

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