MEDICARE: HAVEN EEOI HOLDINGS, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609621275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN EEOI HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	16165 N 83RD AVE STE 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-5816
Country	:	US
Telephone Number	:	866-554-2836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 SILVER HEIGHTS BLVD
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5643
Country	:	US
Telephone Number	:	575-635-3318
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE MANAGER
Name	:	JULIE GOJKOVICH
Credential	:
Telephone Number	:	575-635-3318

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	06/23/2025

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