Healthcare Provider Details

I. General information

NPI: 1336865500
Provider Name (Legal Business Name): HOBBLEVIEW HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W 2230 N STE 240
PROVO UT
84604-7520
US

IV. Provider business mailing address

333 W 2230 N STE 240
PROVO UT
84604-7520
US

V. Phone/Fax

Practice location:
  • Phone: 385-254-0872
  • Fax: 385-254-0877
Mailing address:
  • Phone: 385-254-0872
  • Fax: 385-254-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER SMITH
Title or Position: OWNER
Credential:
Phone: 385-254-0872