Organization
HIGH DESERT HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACEY ALLEN GRAHAM (FACILITY MANAGER)
(760) 240-9896
Entity
Organization
Contact information
Practice address
15448 MONDAMON RD, APPLE VALLEY, CA 92307-4557
(760) 240-9896
(760) 240-9876
Mailing address
PMB 201, 20162 HWY 18, STE G, APPLE VALLEY, CA 92307
(760) 240-9896
(760) 240-9876
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
CA
Other
Enumeration date
01/24/2007
Last updated
08/22/2020
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