MEDICARE: HAVENCARE NURSING & REHABILITATION CENTER

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	117214	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	117214	TX
3	385H00000X	Respite Care	117214	TX
4	332BN1400X	Nursing Facility Supplies (DME)	117214	TX
5	314000000X	Skilled Nursing Facility	117214	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1912997222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVENCARE NURSING & REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	1400 KATY FLEWELLEN RD UNIT 29
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-6633
Country	:	US
Telephone Number	:	713-806-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 RUTHLYNN DR
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-5635
Country	:	US
Telephone Number	:	903-757-2557
Fax Number	:	903-757-5709

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEROY WILLIAMS
Credential	:
Telephone Number	:	713-806-0027

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	06/15/2026