NPIMap

Organization Active NPI

Desert Haven Hospice, LLC

  • Community Based Hospice Care Agency
  • Washington, UT
National Provider Identifier
1669203105
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
DESERT HAVEN HOSPICE, LLC
Practice address
85 N 300 W Ste C
Washington, UT 84780-3563
Phone
(435) 817-6766
Fax
(435) 228-5602
NPI assigned
Aug 7, 2024
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Mr. Jason B Clark
Title
Hospice Administrator
Phone
(435) 817-6766

Specialties & licenses 1

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

Addresses

Primary practice location

85 N 300 W Ste C
Washington, UT 84780-3563

Mailing address

85 N 300 W Ste C
Washington, UT 84780-3563
Phone (435) 817-6766

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250205002045 UT Part A Provider - Hospice 2961937230 Practice locations: Washington, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669203105. Details of each certification follow.

Hospice certification: CCN 461640

Legal name
DESERT HAVEN HOSPICE LLC
Doing business as
HOME CARE HOME BASE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 30, 2025
Last certification
Jun 18, 2025
Organization structure
LLCProprietary
Enrollment address
85 N 300 W
Ste C
Washington, UT 84780-3563

Care Compare: Hospice

Medicare Care Compare
Listed as
Desert Haven Hospice, LLCCCN 461640 · All quality measures
Certified
Jun 30, 2025
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Marcy Clark Individual 5% Or Greater Direct Ownership Interest Apr 9, 2024 100%
Jason Clark Individual Contracted Managing EmployeeCeo Apr 9, 2024
Corporate OfficerCeo Apr 9, 2024 100%

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1669203105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 N 300 W STE C",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847803563",
            "telephone_number": "435-817-6766",
            "fax_number": "435-228-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 N 300 W STE C",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847803563",
            "telephone_number": "435-817-6766",
            "fax_number": "435-228-5602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT HAVEN HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "HOSPICE ADMINISTRATOR",
        "authorized_official_telephone_number": "435-817-6766",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, UT

Sources for this page

Verify at the official NPI Registry.