MEDICARE: HEARTFELT HEALTH HAVEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	261QH0100X	Health Service Clinic/Center
3	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1902650070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTFELT HEALTH HAVEN INC

Provider Business Mailing Address
First Line	:	5238 JAY THRUSH DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4006
Country	:	US
Telephone Number	:	832-868-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5238 JAY THRUSH DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4006
Country	:	US
Telephone Number	:	832-868-2200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RACHEAL BABALOLA
Credential	:
Telephone Number	:	832-868-2200

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	07/23/2024

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