Provider Demographics
NPI:1689433880
Name:HAVEN HOSPICE INC
Entity Type:Organization
Organization Name:HAVEN HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-320-3939
Mailing Address - Street 1:11016 MOCKINGBIRD DR STE 104
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-6317
Mailing Address - Country:US
Mailing Address - Phone:402-320-3939
Mailing Address - Fax:
Practice Address - Street 1:11016 MOCKINGBIRD DR STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-6317
Practice Address - Country:US
Practice Address - Phone:402-320-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based