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General NPI Number Information
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NPI Number | 1467346049
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Entity Type | Organization
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Legal Business Name | PINE HAVEN LLC
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 4803 CHRISTMAS TREE LN
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City | BAKERSFIELD
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State | CA
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Zip | 93306-1767
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Country | US
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Telephone | 818-726-8078
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Fax | 818-279-7616
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Provider Business Mailing Address
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Address Line | 700 N BRAND BLVD STE 860
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City | GLENDALE
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State | CA
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Zip | 91203-1274
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Country | US
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Telephone | 818-726-8078
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Fax | 818-279-7616
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Authorized Official
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Title or Position | CEO
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Name | MR. ALBERT AYVAZYAN
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Credential |
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Telephone | 818-726-8078
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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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