Healthcare Provider Details

I. General information

NPI: 1033031844
Provider Name (Legal Business Name): GRACE HAVEN CONGREGATE LIVING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 TEMPLE AVE
BEAUMONT CA
92223-3154
US

IV. Provider business mailing address

117 TEMPLE AVE
BEAUMONT CA
92223-3154
US

V. Phone/Fax

Practice location:
  • Phone: 817-517-8748
  • Fax:
Mailing address:
  • Phone: 817-517-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BEN ARNOLD ADOM
Title or Position: CEO
Credential: DNP
Phone: 817-517-8748