Provider Demographics
NPI:1043406770
Name:METROHAVEN OF LOVE INC
Entity Type:Organization
Organization Name:METROHAVEN OF LOVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:AREBHUA
Authorized Official - Last Name:ODAMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-421-5894
Mailing Address - Street 1:3110 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-4912
Mailing Address - Country:US
Mailing Address - Phone:214-421-5894
Mailing Address - Fax:214-421-5894
Practice Address - Street 1:3110 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-4912
Practice Address - Country:US
Practice Address - Phone:214-421-5894
Practice Address - Fax:214-421-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
117046251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health