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General NPI Number Information
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NPI Number | 1679810915
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Entity Type | Organization
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Legal Business Name | HAVEN OF COTTONWOOD, LLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 197 S WILLARD ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4123
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Country | US
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Telephone | 928-634-5548
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Fax | 928-634-9602
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Provider Business Mailing Address
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Address Line | 197 S WILLARD ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4123
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Country | US
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Telephone | 928-634-5548
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Fax | 928-634-9602
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Authorized Official
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Title or Position | PRESIDENT
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Name | 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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NCI-2707
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License Number State | AZ
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