# HAVENS FAMILY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619011830
- **Authorized official:** JASON MORGAN PA (OFFICE MANAGER)
- **Authorized official phone:** (719) 276-3211

## Contact information

- **Practice address:** 109 LATIGO LN, SUITE C, CANON CITY, CO 81212-8112
- **Practice address phone:** (719) 276-3211
- **Mailing address:** 109 LATIGO LN, SUITE C, CANON CITY, CO 81212-8112
- **Mailing address phone:** (719) 276-3211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 28791 | CO | Yes |
| 363A00000X | Physician Assistant | 2124 | CO | — |
| 363L00000X | Nurse Practitioner | NP4805 | CO | — |

## Other

- **Enumeration date:** 02/19/2007
- **Last updated:** 03/23/2012