Provider Demographics
NPI:1891478996
Name:HEALTHY HAVEN HEALTHCARE
Entity Type:Organization
Organization Name:HEALTHY HAVEN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:863-528-5627
Mailing Address - Street 1:201 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8232
Mailing Address - Country:US
Mailing Address - Phone:863-528-5627
Mailing Address - Fax:
Practice Address - Street 1:5833 SYCAMORE CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-1918
Practice Address - Country:US
Practice Address - Phone:863-528-5627
Practice Address - Fax:888-752-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty