Healthcare Provider Details

I. General information

NPI: 1629653720
Provider Name (Legal Business Name): HAVEN POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E DATE ST
SAN BERNARDINO CA
92404-4233
US

IV. Provider business mailing address

1311 E DATE ST
SAN BERNARDINO CA
92404-4233
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-3316
  • Fax:
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: RICHARD MARTIN
Title or Position: MANAGER
Credential:
Phone: 909-882-3316