Healthcare Provider Details

I. General information

NPI: 1679152649
Provider Name (Legal Business Name): HAYVEN HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16243 CHASE ST
NORTH HILLS CA
91343-6203
US

IV. Provider business mailing address

16243 CHASE ST
NORTH HILLS CA
91343-6203
US

V. Phone/Fax

Practice location:
  • Phone: 818-812-5688
  • Fax: 818-208-4270
Mailing address:
  • Phone:
  • 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: GREGORY MIKITARIAN
Title or Position: CFO
Credential: RN
Phone: 818-812-5688