- Enrollment id
- O20040602001279
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255337721
- Multiple npi flag
- N
- Ccn
- 679178
- Associate id
- 2163404229
- Organization name
- HAVEN HEALTHCARE SYSTEMS, INC
- Incorporation date
- 2000-11-10
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4615 SOUTHWEST FREEWAY
- Address line 2
- SUITE 740
- City
- HOUSTON
- State
- TX
- Zip code
- 77027