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General NPI Number Information
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NPI Number | 1245121144
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Entity Type | Organization
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Legal Business Name | OLIVE TREE HAVEN, LLC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 969 CYPRESS AVE
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City | COLTON
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State | CA
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Zip | 92324-1957
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Country | US
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Telephone | 760-985-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 9206 HIDDEN FARM RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-1536
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Country | US
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Telephone | 760-985-5555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. RAED EL HAJJAOUI
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Credential | MD
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Telephone | 760-985-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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