MEDICARE: HAVEN CASE MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	47	HI

General Provider Information

NPI Number	:	1013446152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN CASE MANAGEMENT

Provider Business Mailing Address
First Line	:	3418 LIKINI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-2103
Country	:	US
Telephone Number	:	808-351-8396
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 LIKINI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-2103
Country	:	US
Telephone Number	:	808-343-3472
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	JED ASUNCION
Credential	:	RN
Telephone Number	:	808-343-3472

Provider Enumeration Date	:	06/11/2017
Last Update Date	:	06/15/2017

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