Provider Demographics
NPI:1801601521
Name:PREFERRED CARE HAVEN LLC
Entity type:Organization
Organization Name:PREFERRED CARE HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-308-9491
Mailing Address - Street 1:109 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3546
Mailing Address - Country:US
Mailing Address - Phone:857-308-9491
Mailing Address - Fax:
Practice Address - Street 1:109 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-3546
Practice Address - Country:US
Practice Address - Phone:857-308-9491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)