MEDICARE: HEALTH HAVEN CARE 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
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1891659231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH HAVEN CARE LLC

Provider Business Mailing Address
First Line	:	3208 BAYLOR CIR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6164
Country	:	US
Telephone Number	:	404-421-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 BAYLOR CIR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6164
Country	:	US
Telephone Number	:	404-421-2100
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. FOLASHADE MEDUTENI
Credential	:	RN,BSN
Telephone Number	:	404-421-2100

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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