HEAVENLY HAVEN (NPI# 1871044925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871044925 |
| Entity Type | Organization |
| Organization Name | HEAVENLY HAVEN |
| Practice Address |
4748 Clover St Unit A Houston TX 77033-4047 |
| Practice Telephone | 8324338433 |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2019-02-22 |
| Authorized Official Name | ANDREA DYER (CEO/OWNER) |
| Authorized Official Telephone | 8324338433 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 1649628033 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295284727 | Heavenly Haven | Clinic/Center | 4748 Clover St, Unit A, Houston, TX 77033-4047 | 2016-09-26 |
| 1306005996 | Heavenly Haven | Home Health | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2008-06-09 |
| 1659544377 | Heavenly Haven | Home Health | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2008-04-03 |
| 1174794325 | Heavenly Haven | Home Health | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2008-03-17 |
| 1487825741 | Heavenly Haven | Home Health | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2008-03-14 |
| 1740489152 | Heavenly Haven | Home Health | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2007-07-16 |
| 1093913485 | Heavenly Haven | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2007-07-06 |
| 1659577922 | Heavenly Haven | Home Health | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2007-06-25 |
| 1952424194 | Heavenly Haven | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2007-04-10 |
| 1861515009 | Heavenly Haven | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4824 E Brookstown Dr, Baton Rouge, LA 70805-3823 | 2007-04-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | HEAVENLY HAVEN LLC | 1823 N Center Ln, Po Box 11701, Spokane Valley, WA 99211 |
| Colorado Business Entities | Heavenly Haven LLC | 4527 Palmer Park Blvd, Colorado Springs, CO 80915 |
| Street Address |
4748 CLOVER ST UNIT A |
| City | HOUSTON |
| State | TX |
| Zip Code | 77033-4047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295284727 | Heavenly Haven | Clinic/Center | 4748 Clover St, Unit A, Houston, TX 77033-4047 | 2016-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972152023 | Mary L Jones | Technician | 7334 Bastogne Rd., Houston, TX 77033 | 2019-09-10 |
| 1518480813 | Divine Purpose Care Home, LLC | Assisted Living Facility | 5742 Schevers St, Houston, TX 77033 | 2017-07-19 |
| 1669928321 | Jernigan's Medical Services | Home Health | 5910 Kenilwood Drive, Houston, TX 77033 | 2016-08-31 |
| 1356641005 | Jericho House LLC | Assisted Living Facility | 4845 Rue Street, Houston, TX 77033 | 2010-10-28 |
| 1710109004 | Mar Vir Ley Selections | Non-emergency Medical Transport (VAN) | 7723 Belgard Street, Houston, TX 77033 | 2007-05-03 |
| 1134231046 | C & L Pharmacy | Pharmacy | 5600 Mykawa, Houston, TX 77033 | 2006-08-31 |
| 1083104806 | Life Changing Assistance Healthcare, LLC | Home Health | 5025 Doolittle Blvd, Houston, TX 77033 | 2018-05-16 |
| 1245742758 | Odalis Lizeth Valdez | Nurse Practitioner | 5515 South Loop E, Houston, TX 77033 | 2017-10-25 |
| 1124423736 | Deontology | Exclusive Provider Organization | 6022 Belneath St, Houston, TX 77033 | 2014-10-24 |
| 1326002080 | Physicians Dialysis of Houston LLP | Clinic/Center | 5989 South Loop E, Houston, TX 77033-1017 | 2006-04-12 |
| Find all providers in zip 77033 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336766336 | Living Faith Community Home, Inc. | Custodial Care Facility | 10735 Braes Forest Dr, Houston, TX 77071-1501 | 2020-06-25 |
| 1558901249 | Natasha Mosley | Custodial Care Facility | 9027 Weymouth Dr, Houston, TX 77031-3032 | 2020-01-09 |
| 1073097663 | Lawrence Carethers | Custodial Care Facility | 6226 Kashmere St, Houston, TX 77026-1626 | 2018-09-19 |
| 1659852820 | Divinity Care Center | Custodial Care Facility | 5800 Ranchester Dr Ste 188, Houston, TX 77036-2464 | 2018-08-27 |
| 1972032373 | Home for Today | Custodial Care Facility | 1206 Laurel Chase Trail, Houston, TX 77073 | 2017-06-08 |
| 1972034858 | Christine Peltier-mulcare | Custodial Care Facility | 2307 Tomlinson Trail Dr, Houston, TX 77067-3797 | 2017-03-23 |
| 1477092641 | Caring Cove LLC | Custodial Care Facility | 4903 Christopher Pl, Houston, TX 77066-1712 | 2017-02-21 |
| 1912445370 | Lisa M Barrow | Custodial Care Facility | 3110 Kainer Meadows Ln, Houston, TX 77047-6230 | 2017-02-06 |
| 1538604079 | About Living Healthcare Services | Custodial Care Facility | 7600 Creekbend Dr Apt 823, Houston, TX 77071-1849 | 2016-12-19 |
| 1265974232 | Gt Living Center, Inc | Custodial Care Facility | 1414 S Dairy Ashford Rd Apt 801, Houston, TX 77077-2356 | 2016-11-08 |
| Find all providers in HOUSTON | ||||
Please comment or provide details below to improve the information on HEAVENLY HAVEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.