Provider Demographics
NPI:1588395677
Name:HAVEN HOSPICE SERVICES LLC
Entity type:Organization
Organization Name:HAVEN HOSPICE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-316-7396
Mailing Address - Street 1:30218 CASCADING BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-2786
Mailing Address - Country:US
Mailing Address - Phone:347-316-7396
Mailing Address - Fax:
Practice Address - Street 1:30218 CASCADING BROOK WAY
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-2786
Practice Address - Country:US
Practice Address - Phone:347-316-7396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherMEDICARE PART A