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General NPI Number Information
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NPI Number | 1841091816
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Entity Type | Organization
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Legal Business Name | A HAVELI CARE, LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 30578 BELLE GROVE CIR
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City | HOMELAND
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State | CA
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Zip | 92548-7800
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Country | US
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Telephone | 909-736-6502
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Fax |
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Provider Business Mailing Address
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Address Line | 8866 UTICA AVE # 108
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5104
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Country | US
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Telephone | 909-736-6502
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Fax |
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | ALISSA GALES
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Credential |
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Telephone | 909-736-6502
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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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