Provider Demographics
NPI:1457750358
Name:KIYA'S HAVEN ASSISTED LIVING HOME
Entity type:Organization
Organization Name:KIYA'S HAVEN ASSISTED LIVING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:WHYETE-BABERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-467-4933
Mailing Address - Street 1:1611 WINDCHIME DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4816
Mailing Address - Country:US
Mailing Address - Phone:214-467-4933
Mailing Address - Fax:214-467-4933
Practice Address - Street 1:1611 WINDCHIME DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4816
Practice Address - Country:US
Practice Address - Phone:214-467-4933
Practice Address - Fax:214-467-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139938310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility