Healthcare Provider Details

I. General information

NPI: 1013362094
Provider Name (Legal Business Name): HAVEN HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31752 COAST HWY STE #300
LAGUNA BEACH CA
92651-6782
US

IV. Provider business mailing address

31752 COAST HWY STE #300
LAGUNA BEACH CA
92651-6782
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

VIII. Authorized Official

Name: BRETT P ROBERTSON
Title or Position: CEO
Credential:
Phone: 801-296-5100