Provider Demographics
NPI:1063276400
Name:HAVEN CREEK PARTNERS LLC
Entity type:Organization
Organization Name:HAVEN CREEK PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT/OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOWBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:598 W 900 S STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8195
Mailing Address - Country:US
Mailing Address - Phone:801-397-4697
Mailing Address - Fax:801-296-9117
Practice Address - Street 1:4607 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9507
Practice Address - Country:US
Practice Address - Phone:801-732-0060
Practice Address - Fax:801-732-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility