Provider Demographics
NPI:1790530368
Name:HAVEN EEOI HOLDINGS, LLC
Entity Type:Organization
Organization Name:HAVEN EEOI HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOJKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-635-3318
Mailing Address - Street 1:885 PENNIMAN AVE UNIT 6426
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-7722
Mailing Address - Country:US
Mailing Address - Phone:888-891-0786
Mailing Address - Fax:
Practice Address - Street 1:1510 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9033
Practice Address - Country:US
Practice Address - Phone:575-635-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health