Healthcare Provider Details

I. General information

NPI: 1154103497
Provider Name (Legal Business Name): HEALINGHAVEN HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CAMINO DEL RIO N STE 455
SAN DIEGO CA
92108-5720
US

IV. Provider business mailing address

3111 CAMINO DEL RIO N STE 455
SAN DIEGO CA
92108-5720
US

V. Phone/Fax

Practice location:
  • Phone: 619-663-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JUM MICHAEL APOSTOL
Title or Position: OWNER, PRESIDENT
Credential:
Phone: 973-771-8065