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General NPI Number Information
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NPI Number | 1992390884
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Entity Type | Organization
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Legal Business Name | EBEN HAVEN INC
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 30792 STONE CREEK CT
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City | MENIFEE
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State | CA
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Zip | 92584-2722
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Country | US
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Telephone | 195-131-8995
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Fax | 951-246-0368
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Provider Business Mailing Address
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Address Line | 30792 STONE CREEK CT
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City | MENIFEE
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State | CA
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Zip | 92584-2722
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Country | US
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Telephone | 951-318-9956
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Fax | 951-246-0368
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELIZABETH O ODUNJO
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Credential | RN
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Telephone | 951-318-9956
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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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