Healthcare Provider Details

I. General information

NPI: 1457296766
Provider Name (Legal Business Name): HAVEN EEOI HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S CARBON AVE STE 21
PRICE UT
84501-2853
US

IV. Provider business mailing address

23 S CARBON AVE STE 21
PRICE UT
84501-2853
US

V. Phone/Fax

Practice location:
  • Phone: 866-554-2836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIE GOJKOVICH
Title or Position: COMPLIANCE MANAGER
Credential: GOJKOVICH
Phone: 575-635-3318