MEDICARE: HAVEN ASSISTED CARE 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1295587350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN ASSISTED CARE LLC

Provider Business Mailing Address
First Line	:	1817 AVENIDA DEL DIABLO
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92029-3112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 S WINERY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-5011
Country	:	US
Telephone Number	:	559-251-8417
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SCOTT KIRBY
Credential	:
Telephone Number	:	619-201-5888

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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Directions to “HAVEN ASSISTED CARE LLC ” Practice Location

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