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General NPI Number Information
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NPI Number | 1104163435
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Entity Type | Organization
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Legal Business Name | HAVEN OF CAMP VERDE, LLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 86 W SALT MINE RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7013
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Country | US
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Telephone | 928-567-5253
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Fax | 928-567-3794
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Provider Business Mailing Address
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Address Line | 86 W SALT MINE RD
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7013
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Country | US
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Telephone | 928-567-5253
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Fax | 928-567-3794
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRETT P ROBERTSON
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Credential |
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Telephone | 480-935-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NCI-2699
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License Number State | AZ
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