Provider Demographics
NPI:1992390884
Name:EBEN HAVEN INC
Entity Type:Organization
Organization Name:EBEN HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODUNJO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-318-9956
Mailing Address - Street 1:30792 STONE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-2722
Mailing Address - Country:US
Mailing Address - Phone:951-318-9956
Mailing Address - Fax:951-246-0368
Practice Address - Street 1:30792 STONE CREEK CT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-2722
Practice Address - Country:US
Practice Address - Phone:195-131-8995
Practice Address - Fax:951-246-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility