Healthcare Provider Details

I. General information

NPI: 1245148618
Provider Name (Legal Business Name): THE ARK HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 W HACKBERRY AVE
SAN TAN VALLEY AZ
85140-7954
US

IV. Provider business mailing address

21168 E OCOTILLO RD # 1273
QUEEN CREEK AZ
85142-8175
US

V. Phone/Fax

Practice location:
  • Phone: 928-800-0662
  • Fax: 928-470-9284
Mailing address:
  • Phone: 928-800-0662
  • Fax: 928-470-9284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELISA COBB
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 928-800-0662