Provider Demographics
NPI:1679390769
Name:HAVEN OF CARE LLC
Entity type:Organization
Organization Name:HAVEN OF CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHMUDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-523-0449
Mailing Address - Street 1:12500 E ILIFF AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1276
Mailing Address - Country:US
Mailing Address - Phone:303-523-0449
Mailing Address - Fax:303-484-9022
Practice Address - Street 1:12500 E ILIFF AVE STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1276
Practice Address - Country:US
Practice Address - Phone:303-523-0449
Practice Address - Fax:303-484-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health