Healthcare Provider Details

I. General information

NPI: 1730015579
Provider Name (Legal Business Name): SALUS HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12043 LACIE LN
LAKESIDE CA
92040-5444
US

IV. Provider business mailing address

122 SIERRA WAY
CHULA VISTA CA
91911-1434
US

V. Phone/Fax

Practice location:
  • Phone: 619-206-0040
  • Fax:
Mailing address:
  • Phone: 619-206-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE MAGANA
Title or Position: OWNER
Credential:
Phone: 619-206-0040