MEDICARE: HAYVEN HOME, INC.

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	:	1679152649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYVEN HOME, INC.

Provider Business Mailing Address
First Line	:	16243 CHASE ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-6203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16243 CHASE ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-6203
Country	:	US
Telephone Number	:	818-812-5688
Fax Number	:	818-208-4270

Authorized Official
Title or Position	:	CFO
Name	:	GREGORY MIKITARIAN
Credential	:	RN
Telephone Number	:	818-812-5688

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	10/17/2024

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Directions to “HAYVEN HOME, INC. ” Practice Location

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