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General NPI Number Information
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NPI Number | 1124509633
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Entity Type | Organization
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Legal Business Name | GREY HAVENS, LLC
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 12570 COUNTY ROAD 34
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City | PLATTEVILLE
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State | CO
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Zip | 80651-8314
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Country | US
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Telephone | 970-785-2819
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20066
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City | BOULDER
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State | CO
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Zip | 80308-3066
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Country | US
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Telephone | 303-817-4703
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORIEN KATHLEEN HOWE
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Credential | CNA
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Telephone | 303-817-4703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | NA.00749790
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License Number State | CO
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