Provider Demographics
NPI:1689676892
Name:HAVEN ASSOCIATES INC
Entity Type:Organization
Organization Name:HAVEN ASSOCIATES INC
Other - Org Name:HAVEN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRISCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-6000
Mailing Address - Street 1:5292 COLLEGE DR
Mailing Address - Street 2:STE 304
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2960
Mailing Address - Country:US
Mailing Address - Phone:801-676-6000
Mailing Address - Fax:801-676-6001
Practice Address - Street 1:5292 COLLEGE DR
Practice Address - Street 2:STE 304
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2960
Practice Address - Country:US
Practice Address - Phone:801-676-6000
Practice Address - Fax:801-676-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid
UT=========001Medicaid
UT=========003Medicaid
UT=========003Medicaid
UT461540Medicare ID - Type UnspecifiedHOSPICE PROVIDER NUMBER