Healthcare Provider Details

I. General information

NPI: 1467868075
Provider Name (Legal Business Name): HAVEN OF GLOBE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MONROE ST
GLOBE AZ
85501-1363
US

IV. Provider business mailing address

1100 E. MONROE STREET
GLOBE AZ
85501
US

V. Phone/Fax

Practice location:
  • Phone: 801-296-5100
  • Fax:
Mailing address:
  • Phone: 801-296-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier011678
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name: BRETT ROBERTSON
Title or Position: CEO
Credential:
Phone: 480-935-4300