MEDICARE: HAVEN OF HOPE, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1912495441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN OF HOPE, INC.

Provider Business Mailing Address
First Line	:	262 NORTH AVE
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-4413
Country	:	US
Telephone Number	:	831-345-2238
Fax Number	:	831-426-6348

Provider Business Practice Location Address
First Line	:	262 NORTH AVE
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-4413
Country	:	US
Telephone Number	:	831-425-3010
Fax Number	:	831-426-6348

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAVINA RENE POLANCO
Credential	:
Telephone Number	:	831-425-3010

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	11/05/2025

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