NPIMap

Organization Active NPI

Haven Home Health LLC

Doing business as Haven Hospice

  • Community Based Hospice Care Agency
  • Ozark, MO
National Provider Identifier
1174920292
Registry record updated Aug 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HAVEN HOME HEALTH LLC
Doing business as
Haven Hospice
Practice address
850 N 25TH St
Ozark, MO 65721-8033
Phone
(417) 581-1234
Fax
(888) 844-7031
NPI assigned
Dec 4, 2014
Last updated
Aug 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Ross RayNPI 1154597524
Title
Ceo
Phone
(417) 581-1234

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

850 N 25TH St
Ozark, MO 65721-8033

Mailing address

850 N 25TH St
Ozark, MO 65721-9164
Phone (417) 581-1234

Other names 1

  • Haven Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150518000393 MO Part A Provider - Hospice 3476701707 Practice locations: Ozark, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174920292. Details of each certification follow.

Hospice certification: CCN 261662

Legal name
HAVEN HOME HEALTH, LLC
Doing business as
HAVEN HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 17, 2016
Last certification
Mar 1, 2019
Ownership / control type
Proprietary - Individual
Organization structure
LLCProprietary
Incorporated
Sep 29, 2011 in MO
Enrollment address
850 N 25TH St
Ozark, MO 65721-8033

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Haven HospiceCCN 261662 · All quality measures
Ownership
For-Profit
Certified
Mar 17, 2016
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Haven Home Health LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1531 E 32nd St
Ste 11
Joplin, MO 64804
Phone (417) 581-1234

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John R Ray Individual 5% Or Greater Direct Ownership InterestCeo Jan 9, 2015 100%
Kim Therriault Individual W-2 Managing EmployeeAd; Jul 11, 2015
Billy D Holt Individual Contracted Managing EmployeeMD; May 27, 2015
Bethany M Ray Individual Operational/Managerial ControlDirector Clinical Operations Jan 9, 2015

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501545600000",
    "number": "1174920292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 N 25TH ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657219164",
            "telephone_number": "417-581-1234",
            "fax_number": "888-844-7031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N 25TH ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657218033",
            "telephone_number": "417-581-1234",
            "fax_number": "888-844-7031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2017-08-01",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-581-1234"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haven Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ozark, MO

Sources for this page

Verify at the official NPI Registry.