Provider Demographics
NPI:1417098302
Name:GREEN HAVEN MANAGEMENT
Entity Type:Organization
Organization Name:GREEN HAVEN MANAGEMENT
Other - Org Name:BEEHIVE HOMES OF CEDAR CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-590-1226
Mailing Address - Street 1:332 S 400 E
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3461
Mailing Address - Country:US
Mailing Address - Phone:435-876-8641
Mailing Address - Fax:
Practice Address - Street 1:332 S 400 E
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3461
Practice Address - Country:US
Practice Address - Phone:435-876-8641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-ALI-865310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility