Havendale LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

28273601 Issued in PA

Legal business name

HAVENDALE LLC

Doing business as

FirstLight HomeCare Southwest Pittsburgh

Practice address

3244 Washington Rd
Suite 239
MC Murray, PA 15317-6403

Phone

(724) 914-8929

Fax

(724) 941-4299

NPI assigned

Jun 25, 2015

Last updated

Jun 20, 2016By 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

Mr. Mykal Kousins

Title

Owner/Ceo

Phone

(724) 914-9829

Specialties & licenses 2

Addresses

Other names 1

• FirstLight HomeCare Southwest Pittsburgh Doing business as

Locations

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466380800000",
    "number": "1720460785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3244 WASHINGTON RD",
            "address_2": "SUITE 239",
            "city": "MC MURRAY",
            "state": "PA",
            "postal_code": "153176403",
            "telephone_number": "724-914-8929",
            "fax_number": "724-941-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3244 WASHINGTON RD",
            "address_2": "SUITE 239",
            "city": "MC MURRAY",
            "state": "PA",
            "postal_code": "153176403",
            "telephone_number": "724-914-8929",
            "fax_number": "724-941-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVENDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2016-06-20",
        "status": "A",
        "authorized_official_last_name": "KOUSINS",
        "authorized_official_first_name": "MYKAL",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "724-914-9829",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "28273601",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "28273601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FirstLight HomeCare Southwest Pittsburgh",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• In Home Supportive Care Agency in McMurray, PA
• Providers in McMurray, PA by specialty
• In Home Supportive Care Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; 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.