Healthcare Provider Details

I. General information

NPI: 1689676892
Provider Name (Legal Business Name): HAVEN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 COLLEGE DR STE 304
MURRAY UT
84123-2960
US

IV. Provider business mailing address

5292 COLLEGE DR STE 304
MURRAY UT
84123-2960
US

V. Phone/Fax

Practice location:
  • Phone: 801-676-6000
  • Fax: 801-676-6001
Mailing address:
  • Phone: 801-676-6000
  • Fax: 801-676-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateUT

VIII. Authorized Official

Name: MR. JOHN A GRISCAVAGE
Title or Position: CEO
Credential:
Phone: 801-676-6000