Provider Demographics
NPI:1104867613
Name:MANNA HAVEN CARE SERVICES
Entity Type:Organization
Organization Name:MANNA HAVEN CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:IHUA-MADUENYI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:817-681-2226
Mailing Address - Street 1:501 MATADOR ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2218
Mailing Address - Country:US
Mailing Address - Phone:817-681-2226
Mailing Address - Fax:940-568-9294
Practice Address - Street 1:501 MATADOR ST
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-2218
Practice Address - Country:US
Practice Address - Phone:817-681-2226
Practice Address - Fax:940-568-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010490251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747130Medicare Oscar/Certification