Healthcare Provider Details

I. General information

NPI: 1932083417
Provider Name (Legal Business Name): HEIDI'S HAVEN LLC TBI BEHAVIORAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 S BRICE
MESA AZ
85212-7116
US

IV. Provider business mailing address

4455 S BRICE
MESA AZ
85212-7116
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-0398
  • Fax:
Mailing address:
  • Phone: 480-374-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. HEIDI ESPARZA
Title or Position: ALF MANAGER
Credential:
Phone: 480-374-0398