Provider Demographics
NPI:1639832710
Name:HAVEN ENTERPRISE
Entity Type:Organization
Organization Name:HAVEN ENTERPRISE
Other - Org Name:HAVEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROSALES
Authorized Official - Last Name:DULDULAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-465-3594
Mailing Address - Street 1:2886 SPANISH BAY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4634
Mailing Address - Country:US
Mailing Address - Phone:909-465-3594
Mailing Address - Fax:
Practice Address - Street 1:3600 CLAYTON RD STE E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2572
Practice Address - Country:US
Practice Address - Phone:925-349-9513
Practice Address - Fax:925-349-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based