Provider Demographics
NPI:1346565595
Name:HAVENWOOD CAREGIVER SERVICES
Entity Type:Organization
Organization Name:HAVENWOOD CAREGIVER SERVICES
Other - Org Name:OKEEFFE ENTERPRISES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-327-1011
Mailing Address - Street 1:2417 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5907
Mailing Address - Country:US
Mailing Address - Phone:208-327-1011
Mailing Address - Fax:208-327-1411
Practice Address - Street 1:303 E WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1578
Practice Address - Country:US
Practice Address - Phone:509-535-1546
Practice Address - Fax:509-535-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000308253Z00000X
IDM8072875253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA359880OtherWASHINGTON STATE ALTCEW
WA359880Medicaid
IDM8072875Medicaid