Provider Demographics
NPI:1124509633
Name:GREY HAVENS, LLC
Entity type:Organization
Organization Name:GREY HAVENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORIEN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:303-817-4703
Mailing Address - Street 1:PO BOX 20066
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-3066
Mailing Address - Country:US
Mailing Address - Phone:303-817-4703
Mailing Address - Fax:
Practice Address - Street 1:12570 COUNTY ROAD 34
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:CO
Practice Address - Zip Code:80651-8314
Practice Address - Country:US
Practice Address - Phone:970-785-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.00749790376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty