Healthcare Provider Details

I. General information

NPI: 1922923770
Provider Name (Legal Business Name): HAVEN HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N 25TH ST
OZARK MO
65721-8033
US

IV. Provider business mailing address

850 N 25TH ST
OZARK MO
65721-8033
US

V. Phone/Fax

Practice location:
  • Phone: 417-731-7055
  • Fax: 888-550-3518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN ROSS RAY
Title or Position: CEO
Credential:
Phone: 417-496-5958