The Haven Home

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

139524 Issued in TX

Legal business name

THE HAVEN HOME

Practice address

1216 Holt Ave
Desoto, TX 75115-3110

Phone

(972) 803-5605

Fax

(972) 803-5605

NPI assigned

Jun 5, 2014

Last updated

Jun 5, 2014By 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. Schnikwa Las Hicks, NA

Title

Owner

Phone

(469) 734-7674

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1265845499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 HOLT AVE",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153110",
            "telephone_number": "972-803-5605",
            "fax_number": "972-803-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 HOLT AVE",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153110",
            "telephone_number": "972-803-5605",
            "fax_number": "972-803-5605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HAVEN HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "SCHNIKWA",
        "authorized_official_middle_name": "LAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-734-7674",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NA"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "TX",
            "license": "139524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in Desoto, TX
• Providers in Desoto, TX by specialty
• Health Maintenance Organization in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.