Provider Demographics
NPI:1669203105
Name:DESERT HAVEN HOSPICE, LLC
Entity type:Organization
Organization Name:DESERT HAVEN HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-817-6766
Mailing Address - Street 1:85 N 300 W STE C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3563
Mailing Address - Country:US
Mailing Address - Phone:435-817-6766
Mailing Address - Fax:435-228-5602
Practice Address - Street 1:85 N 300 W STE C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-3563
Practice Address - Country:US
Practice Address - Phone:435-817-6766
Practice Address - Fax:435-228-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based