Healthcare Provider Details

I. General information

NPI: 1619665247
Provider Name (Legal Business Name): HAVEN SENIOR HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COMANCHE NE BLDG F SUITE 200
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

3500 COMANCHE NE BLDG F SUITE 200
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-2275
  • Fax:
Mailing address:
  • Phone: 505-275-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY LOPEZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 505-249-8282