NPIMap

Organization Active NPI

Haven of Camp Verde, LLC

  • Skilled Nursing Facility
  • Camp Verde, AZ
National Provider Identifier
1104163435
Registry record updated Jan 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCI-2699 Issued in AZ
Legal business name
HAVEN OF CAMP VERDE, LLC
Practice address
86 W Salt Mine Rd
Camp Verde, AZ 86322-7013
Phone
(928) 567-5253
Fax
(928) 567-3794
NPI assigned
Jan 7, 2013
Organization subpart
Yes
Parent organization
HAVEN HEALTH GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brett P Robertson
Title
President
Phone
(480) 935-4300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NCI-2699 AZ Primary

Addresses

Primary practice location

86 W Salt Mine Rd
Camp Verde, AZ 86322-7013

Mailing address

86 W Salt Mine Rd
Camp Verde, AZ 86322-7013
Phone (928) 567-5253

Other identifiers 1

IdentifierTypeStateIssuer
813324MedicaidAZ

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130326000542 AZ Part A Provider - Skilled Nursing Facility 8123263977 Practice locations: Camp Verde, AZ

Skilled nursing facility certification: CCN 035118

Legal name
HAVEN OF CAMP VERDE LLC
Doing business as
HEALTH GROUP MANAGEMENT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 13, 1985
Last certification
Jan 30, 2025
Beds
58
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
86 West Salt Mine Road
Camp Verde, AZ 86322-7013
Nursing home name
HAVEN OF CAMP VERDE
Affiliated entity
HAVEN HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Haven of Camp VerdeCCN 035118
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 13, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5848.0 residents per day on average
Chain
Haven Health20 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $11,864

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Part of
Haven Health Group LLC

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christian R West Individual 5% Or Greater Direct Ownership InterestManager Feb 1, 2013 6.4%
Operational/Managerial Control Jan 21, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 6.4%
Neeraj K Vij Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Haven Real Estate Partners, LLC Organization, Laguna Beach, CA Created for acquisition 5% Or Greater Mortgage Interest Feb 1, 2013 100%
Adp of the SNF Dec 2, 2024
Haven Camp Verde Real Estate LLC Organization, Laguna Beach, CA Created for acquisition, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 1, 2013 100%
Adp of the SNF Dec 3, 2024
Haven Arizona Real Estate, LLC Organization, Laguna Beach, CA Created for acquisition, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 1, 2013 100%
Adp of the SNF Dec 3, 2024
Rodrigo Santos Individual Operational/Managerial Control Oct 2, 2024
Adp of the SNF Oct 2, 2024
Stephen Samuelian Individual 5% Or Greater Direct Ownership InterestManager Feb 1, 2013 36.73%
Operational/Managerial Control Jan 22, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 36.73%
Robert Samuelian Individual 5% Or Greater Direct Ownership InterestManager Feb 1, 2013 20.13%
Operational/Managerial Control Jan 22, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 20.13%
Spencer R Samuelian Individual 5% Or Greater Direct Ownership Interest Feb 1, 2013 25.21%
Operational/Managerial Control Jan 21, 2025
Adp of the SNF Jan 21, 2025
Direct Ownership Interest Feb 1, 2013 25.21%
Stephanie Espinosa Individual Operational/Managerial Control Oct 14, 2024
Adp of the SNF Oct 14, 2024
Jason J Seastrand Individual Operational/Managerial Control Feb 1, 2013
Adp of the SNF Feb 1, 2013
Direct Ownership Interest Feb 1, 2013 3.92%
Lindsay Fragoso Individual Operational/Managerial Control May 10, 2021
Adp of the SNF May 10, 2021
Debra Comeau Individual Operational/Managerial Control Sep 16, 2024
Adp of the SNF Sep 16, 2024
Brett P Robertson Individual 5% Or Greater Direct Ownership InterestManager/President/Ceo Feb 1, 2013 7.61%
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 7.61%
Haven Health Group LLC Organization, Laguna Beach, CA Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Feb 1, 2013 100%
Stock Longhurst Individual Operational/Managerial Control Nov 15, 2020
Adp of the SNF Nov 15, 2020
Health Group Management LLC Organization, Laguna Beach, CA Management services company Operational/Managerial Control Nov 25, 2024
Adp of the SNF Nov 25, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 30

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 30

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769126400000",
    "number": "1104163435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 W SALT MINE RD",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "863227013",
            "telephone_number": "928-567-5253",
            "fax_number": "928-567-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 W SALT MINE RD",
            "city": "CAMP VERDE",
            "state": "AZ",
            "postal_code": "863227013",
            "telephone_number": "928-567-5253",
            "fax_number": "928-567-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN OF CAMP VERDE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN HEALTH GROUP LLC",
        "enumeration_date": "2013-01-07",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-935-4300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-2699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "813324",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "csv",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Camp Verde, AZ

Sources for this page

Verify at the official NPI Registry.