Provider Demographics
NPI:1811542814
Name:HAVEN HOME PHYSICIANS LLC
Entity Type:Organization
Organization Name:HAVEN HOME PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMA/BILING
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DESILETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-916-3242
Mailing Address - Street 1:15551 N GREENWAY-HAYDEN LOOP
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:888-752-8055
Mailing Address - Fax:888-491-8760
Practice Address - Street 1:15551 N GREENWAY-HAYDEN LOOP
Practice Address - Street 2:SUITE 155
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:888-752-8055
Practice Address - Fax:888-491-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty