Organization
SURE HAVEN INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE FENNELLY (CEO)
(702) 305-9167
Entity
Organization
Contact information
Practice address
2900 BRISTOL ST, COSTA MESA, CA 92626-5981
(702) 305-9167
(949) 209-5490
Mailing address
2900 BRISTOL ST, SUITE B202, COSTA MESA, CA 92626-5981
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300235QP
CA DHCS
CA
Enumeration date
11/28/2012
Last updated
12/28/2018
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