Healthcare Provider Details

I. General information

NPI: 1306721493
Provider Name (Legal Business Name): CO CARE HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 ARISTA PL UNIT 100
BROOMFIELD CO
80021-7916
US

IV. Provider business mailing address

12810 JARVIS AVE
LOS ANGELES CA
90061-2244
US

V. Phone/Fax

Practice location:
  • Phone: 310-562-1507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CURTIS CARREL JOHNSON
Title or Position: OWNER
Credential:
Phone: 310-562-1507