Provider Demographics
NPI:1235900416
Name:HAVEN HEALTHKARE SERVICES
Entity Type:Organization
Organization Name:HAVEN HEALTHKARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMENKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-248-6394
Mailing Address - Street 1:5320 N MAIN ST # 2A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3657
Mailing Address - Country:US
Mailing Address - Phone:937-567-0638
Mailing Address - Fax:937-567-0698
Practice Address - Street 1:5320 N MAIN ST # 2A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3657
Practice Address - Country:US
Practice Address - Phone:937-567-0638
Practice Address - Fax:937-567-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health