Country Haven Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

119106 Issued in TX

Legal business name

COUNTRY HAVEN ASSISTED LIVING, INC.

Practice address

13812 Hiram Rd
Wills Point, TX 75169-8652

Phone

(972) 524-9884

Fax

(972) 524-9884

NPI assigned

Dec 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Juanita M. Berg, R.N.

Title

President

Phone

(972) 524-9884

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073677951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13812 HIRAM RD",
            "city": "WILLS POINT",
            "state": "TX",
            "postal_code": "751698652",
            "telephone_number": "972-524-9884",
            "fax_number": "972-524-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13812 HIRAM RD",
            "city": "WILLS POINT",
            "state": "TX",
            "postal_code": "751698652",
            "telephone_number": "972-524-9884",
            "fax_number": "972-524-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY HAVEN ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-524-9884",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "119106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Kaye Brown, LM, CPM
• City of Wills Point
• City of Wills Point EMS
• Elizabeth Ann Collins-Lee, LPC
• Cosmic Home Healthcare Inc. (New Life Home Healthcare)
• Crestwood SCC LLC (Free State Crestwood)
• Crestwood SCC LLC (Free State Crestwood)
• Donna Kay Daniels, FNP-C
• Jessica Debaun
• Brandi Leshay Donaldson, FNP STUDENT

• Assisted Living Facility in Wills Point, TX
• Providers in Wills Point, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.