Healthcare Provider Details

I. General information

NPI: 1871350017
Provider Name (Legal Business Name): HAVENLY YOURS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44811 SAN CLEMENTE CIR
PALM DESERT CA
92260-3556
US

IV. Provider business mailing address

73387 GUADALUPE AVE
PALM DESERT CA
92260-2862
US

V. Phone/Fax

Practice location:
  • Phone: 818-629-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: OLIVER PARKER
Title or Position: PRESIDENT
Credential:
Phone: 818-629-6070