Healthcare Provider Details

I. General information

NPI: 1639891872
Provider Name (Legal Business Name): HAVEN GARROTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CHURCHILL ST
EUGENE OR
97405-1008
US

IV. Provider business mailing address

2201 PIERCE ST
EUGENE OR
97405-1624
US

V. Phone/Fax

Practice location:
  • Phone: 541-359-7977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: