Healthcare Provider Details

I. General information

NPI: 1417867011
Provider Name (Legal Business Name): WHOLESOME HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10034 VIEW CREST CT
SPRING VALLEY CA
91977-3125
US

IV. Provider business mailing address

5568 LARAMIE WAY
SAN DIEGO CA
92120-1448
US

V. Phone/Fax

Practice location:
  • Phone: 818-749-6701
  • Fax:
Mailing address:
  • Phone: 818-749-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL SANCHEZ
Title or Position: OWNER AND ADMINISTRATOR
Credential: MDIV
Phone: 818-749-6701