Provider Demographics
NPI:1841219094
Name:JAVANA HEALTHCARE INC
Entity Type:Organization
Organization Name:JAVANA HEALTHCARE INC
Other - Org Name:GARDENDALE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-368-2442
Mailing Address - Street 1:10300 N CENTRAL EXPRESSWAY
Mailing Address - Street 2:SUITE 548
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-368-2442
Mailing Address - Fax:214-373-3357
Practice Address - Street 1:10300 N CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 548
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-368-2442
Practice Address - Fax:214-373-3357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALLIATIVE SERVICES GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-19
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014465251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453138Medicare UPIN