Provider Demographics
NPI:1932625415
Name:HAVEN OF GROOMING
Entity Type:Organization
Organization Name:HAVEN OF GROOMING
Other - Org Name:GROOM THEORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-606-9754
Mailing Address - Street 1:51 FLORISSANT OAKS SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-3934
Mailing Address - Country:US
Mailing Address - Phone:314-933-6883
Mailing Address - Fax:
Practice Address - Street 1:51 FLORISSANT OAKS SHOP CENTER
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-933-6883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150003331744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty