Provider Demographics
NPI:1700654191
Name:HAVEN SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:HAVEN SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DHARMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-608-7321
Mailing Address - Street 1:9120 HAVEN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO CUCUAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5413
Mailing Address - Country:US
Mailing Address - Phone:909-295-5060
Mailing Address - Fax:909-295-5061
Practice Address - Street 1:9120 HAVEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO CUCUAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5413
Practice Address - Country:US
Practice Address - Phone:909-295-5060
Practice Address - Fax:909-295-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty