Care Haven LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

CARE HAVEN LLC

Practice address

1746 30TH LN SW FL 33774
Largo, FL 33774-1415

Phone

(727) 637-8615

Fax

(813) 925-6184

NPI assigned

Jan 28, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Julia V Dervisevic, RN BSN

Title

Co-Owner

Phone

(727) 637-8615

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Care Haven Other name

Electronic endpoints 1

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1679226773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 COLONY LN",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337702963",
            "telephone_number": "727-637-8615",
            "fax_number": "813-925-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1746 30TH LN SW FL 33774",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337741415",
            "telephone_number": "727-637-8615",
            "fax_number": "813-925-6184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "702 10th St NW Fl 33770",
            "address_purpose": "LOCATION",
            "city": "Largo",
            "state": "FL",
            "postal_code": "337702386",
            "country_code": "US",
            "telephone_number": "727-687-4245",
            "fax_number": "813-925-6184",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2290 8th Ave SW # 2290",
            "address_purpose": "LOCATION",
            "city": "Largo",
            "state": "FL",
            "postal_code": "337702940",
            "country_code": "US",
            "telephone_number": "727-637-8615",
            "fax_number": "813-925-6184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARE HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "DERVISEVIC",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "727-637-8615",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN BSN"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008423100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "URL",
            "affiliation": "N",
            "endpointDescription": "URL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1746 30th Ln SW Fl 33774",
            "city": "Largo",
            "state": "FL",
            "country_code": "US",
            "postal_code": "337741415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Care Haven",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Largo, FL
• Providers in Largo, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.