NPIMap

Organization Active NPI

Haven of Phoenix, LLC

  • Skilled Nursing Facility
  • Phoenix, AZ
National Provider Identifier
1215383237
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HAVEN OF PHOENIX, LLC
Practice address
4202 N 20TH Ave
Phoenix, AZ 85015-5101
Phone
(602) 264-3824
NPI assigned
May 9, 2016
Last updated
May 22, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
HAVEN HEALTH GROUP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Authorized official

Name
Brett P Robertson
Title
Ceo
Phone
(480) 935-4300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

4202 N 20TH Ave
Phoenix, AZ 85015-5101

Mailing address

4202 N 20TH Ave
Phoenix, AZ 85015-5101

Other identifiers 1

IdentifierTypeStateIssuer
231351MedicaidAZ

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
O20161118001633 AZ Part A Provider - Skilled Nursing Facility 2961781778 Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215383237. Details of each certification follow.

Skilled nursing facility certification: CCN 035107

Legal name
HAVEN OF PHOENIX LLC
Doing business as
HEALTH GROUP MANAGEMENT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 24, 1985
Last certification
Jan 24, 2025
Beds
114
Ownership / control type
Corporation
Multi-facility organization
see paper 671
Organization structure
LLCProprietary
Incorporated
Mar 8, 2016 in AZ
Enrollment address
4202 N 20TH Ave
Phoenix, AZ 85015-5101
Nursing home name
HAVEN OF PHOENIX
Affiliated entity
HAVEN HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Haven of PhoenixCCN 035107 · All quality measures
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 - Corporation
Certified
Jun 24, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
114106.9 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 $8,278

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2189414Haven of Phoenix4202 N 20TH Ave, Phoenix, AZ 85015Certificate of waiverJul 29, 2028

National Provider Directory

National Provider Directory
Part of
Haven Health Group LLC

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Hemang M Gandhi Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Christian R West Individual 5% Or Greater Direct Ownership InterestMember Jun 1, 2016 6.4%
Operational/Managerial Control Jun 1, 2016
Adp of the SNF Jun 1, 2016
Direct Ownership Interest Jun 1, 2016 6.4%
Haven Health Properties LLC Organization, Laguna Beach, CA Created for acquisition 5% Or Greater Mortgage Interest Jun 1, 2016 100%
Adp of the SNF Nov 25, 2024
Russell Greiner Individual Operational/Managerial Control Aug 16, 2023
Adp of the SNF Aug 16, 2023
Stephen Samuelian Individual 5% Or Greater Direct Ownership InterestManager Jun 1, 2016 36.73%
Adp of the SNF Dec 18, 2024
Robert Samuelian Individual 5% Or Greater Direct Ownership InterestManager Jun 1, 2016 20.13%
Adp of the SNF Dec 18, 2024
Spencer R Samuelian Individual 5% Or Greater Direct Ownership InterestManager/Coo Jun 1, 2016 25.21%
Adp of the SNF Dec 18, 2024
Bahaledin Ahmed Individual Operational/Managerial Control Jun 1, 2016
Adp of the SNF Jun 1, 2016
Haven Phoenix Real Estate LLC Organization, Laguna Beach, CA Created for acquisition, Owned by another organization or individual 5% Or Greater Mortgage Interest Jun 1, 2016 100%
Adp of the SNF Nov 26, 2024
Jason J Seastrand Individual Operational/Managerial Control Jun 1, 2016
Adp of the SNF Jun 1, 2016
Direct Ownership Interest Jun 1, 2016 3.92%
Lindsay Fragoso Individual Operational/Managerial Control May 10, 2021
Adp of the SNF May 10, 2021
Brett P Robertson Individual 5% Or Greater Direct Ownership InterestCeo/President Jun 1, 2016 7.61%
Adp of the SNF Dec 18, 2024
Shelly R. Koker Individual Operational/Managerial Control Jan 5, 2026
Adp of the SNF Jan 5, 2026
Haven Health Group LLC Organization, Laguna Beach, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2016 100%
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 2

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 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

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": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1215383237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 N 20TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 N 20TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155101",
            "telephone_number": "602-264-3824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN OF PHOENIX, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN HEALTH GROUP LLC",
        "enumeration_date": "2016-05-09",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-935-4300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231351",
            "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": "CSV",
            "contentTypeDescription": "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 Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.