MEDICARE: HAVEN HEALTH GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1013362094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	31752 COAST HWY
Second Line	:	STE #300
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6782
Country	:	US
Telephone Number	:	801-296-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	31752 COAST HWY
Second Line	:	STE #300
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6782
Country	:	US
Telephone Number	:	801-296-5100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRETT P ROBERTSON
Credential	:
Telephone Number	:	801-296-5100

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	03/20/2023

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