Organization
HAVENCARE NURSING & REHABILITATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEROY WILLIAMS (PRESIDENT)
(281) 574-7495
Entity
Organization
Contact information
Practice address
111 RUTHLYNN DR, LONGVIEW, TX 75605-5635
(903) 757-2557
(903) 757-5709
Mailing address
111 RUTHLYNN DR, LONGVIEW, TX 75605-5635
(903) 757-2557
(903) 757-5709
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
117214
TX
314000000X
Skilled Nursing Facility
Primary
117214
TX
332B00000X
Durable Medical Equipment & Medical Supplies
117214
TX
332BN1400X
Nursing Facility Supplies (DME)
117214
TX
385H00000X
Respite Care
117214
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001003942
—
TX
05
—
171335601
—
TX
05
—
171335602
—
TX
Enumeration date
10/27/2005
Last updated
07/06/2012
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