Healthcare Provider Details

I. General information

NPI: 1104163435
Provider Name (Legal Business Name): HAVEN OF CAMP VERDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W SALT MINE RD
CAMP VERDE AZ
86322-7013
US

IV. Provider business mailing address

86 W SALT MINE RD
CAMP VERDE AZ
86322-7013
US

V. Phone/Fax

Practice location:
  • Phone: 928-567-5253
  • Fax: 928-567-3794
Mailing address:
  • Phone: 928-567-5253
  • Fax: 928-567-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI-2699
License Number StateAZ

VIII. Authorized Official

Name: MR. BRETT P ROBERTSON
Title or Position: PRESIDENT
Credential:
Phone: 480-935-4300