Provider Demographics
NPI:1255337721
Name:HAVEN HEALTHCARE SYSTEMS, INC
Entity type:Organization
Organization Name:HAVEN HEALTHCARE SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-464-1342
Mailing Address - Street 1:4615 SOUTHWEST FWY STE 740
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7186
Mailing Address - Country:US
Mailing Address - Phone:713-464-1342
Mailing Address - Fax:713-464-1638
Practice Address - Street 1:4615 SOUTHWEST FWY STE 740
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7186
Practice Address - Country:US
Practice Address - Phone:713-464-1342
Practice Address - Fax:713-464-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007981251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-9178Medicare ID - Type Unspecified