Provider Demographics
NPI:1346031093
Name:HAVEN SPRINGS AT TANQUE VERDE LLC
Entity type:Organization
Organization Name:HAVEN SPRINGS AT TANQUE VERDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JITENDRABHAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-223-5792
Mailing Address - Street 1:8850 E CALLE BOLIVAR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8850 E CALLE BOLIVAR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5620
Practice Address - Country:US
Practice Address - Phone:520-223-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility