# HAVEN OF DOUGLAS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HAVEN HEALTH GROUP ARIZONA, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073850319
- **Legal business name:** HAVEN HEALTH GROUP ARIZONA, LLC
- **Authorized official:** BRETT P ROBERTSON (PRESIDENT)
- **Authorized official phone:** (480) 935-4300

## Contact information

- **Practice address:** 1400 N SAN ANTONIO AVE, DOUGLAS, AZ 85607-2434
- **Practice address phone:** (520) 364-7937
- **Practice address fax:** (520) 805-9146
- **Mailing address:** 1400 N SAN ANTONIO AVE, DOUGLAS, AZ 85607-2434
- **Mailing address phone:** (520) 364-7937
- **Mailing address fax:** (520) 805-9146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NCI-2708 | AZ | Yes |
| 314000000X | Skilled Nursing Facility | — | NULL | — |

## Other

- **Enumeration date:** 01/07/2013
- **Last updated:** 05/22/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 813298 | — | AZ |