Autumn Haven Residential Facility

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

AUTUMN HAVEN RESIDENTIAL FACILITY

Practice address

2507 Earlcove Dr
Dallas, TX 75227-7817

Phone

(469) 992-0389

Fax

(972) 637-9225

NPI assigned

Jan 16, 2023

Organization subpart

No

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

Authorized official

Name

Alicia Dennis

Title

Owner

Phone

(469) 254-1298

Specialties & licenses 3

Addresses

Other names 1

• Habor Haven Home Healthcare Services LLC Other name

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1710692736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 EARLCOVE DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752277817",
            "telephone_number": "469-992-0389",
            "fax_number": "972-637-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 EARLCOVE DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752277817",
            "telephone_number": "469-992-0389",
            "fax_number": "972-637-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN HAVEN RESIDENTIAL FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-14",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-254-1298"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Habor Haven Home Healthcare Services LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Dallas, TX
• Providers in Dallas, 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 Jan 16, 2023; 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.