MEDICARE: EVERHAVEN INTEGRATED SERVICES 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	103K00000X	Behavior Analyst
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1821948977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERHAVEN INTEGRATED SERVICES LLC

Provider Business Mailing Address
First Line	:	1673 LION ST
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1673 LION ST
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-5735
Country	:	US
Telephone Number	:	408-668-4373
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINE NICOLE M CHI
Credential	:
Telephone Number	:	408-668-4373

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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