Provider Demographics
NPI:1528856952
Name:HAVENS, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HAVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79403-1401
Mailing Address - Country:US
Mailing Address - Phone:360-904-9092
Mailing Address - Fax:
Practice Address - Street 1:3201 CANYON RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403-1401
Practice Address - Country:US
Practice Address - Phone:360-904-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility