Provider Demographics
NPI:1740671890
Name:RELIABLE HAVEN HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:RELIABLE HAVEN HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:AIZOMOAN
Authorized Official - Last Name:TONY-ITOYAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:214-516-8673
Mailing Address - Street 1:8708 YOSEMITE TRL
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2208
Mailing Address - Country:US
Mailing Address - Phone:214-516-8673
Mailing Address - Fax:
Practice Address - Street 1:8708 YOSEMITE TRL
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2208
Practice Address - Country:US
Practice Address - Phone:214-516-8673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health