Healthcare Provider Details

I. General information

NPI: 1154905305
Provider Name (Legal Business Name): VALLEY HAVEN ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 HARRIS GRADE RD
LOMPOC CA
93436-2211
US

IV. Provider business mailing address

2800 HARRIS GRADE RD
LOMPOC CA
93436-2211
US

V. Phone/Fax

Practice location:
  • Phone: 805-733-9459
  • Fax:
Mailing address:
  • Phone: 805-733-9459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. COLODIA OWENS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 805-733-9459