NPIMap

Organization Active NPI

High Desert Haven

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Apple Valley, CA
National Provider Identifier
1245385863
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
HIGH DESERT HAVEN
Practice address
15448 Mondamon Rd
Apple Valley, CA 92307-4557
Phone
(760) 240-9896
Fax
(760) 240-9876
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Tracey Allen Graham
Title
Facility Manager
Phone
(760) 240-9896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X CA Primary

Addresses

Primary practice location

15448 Mondamon Rd
Apple Valley, CA 92307-4557

Mailing address

PMB 201
20162 Hwy 18, Ste G
Apple Valley, CA 92307
Phone (760) 240-9896

National Provider Directory

National Provider Directory
Tax ID family
High Desert Haven Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

20162 Outer Highway 18
Ste G
Apple Valley, CA 92307

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245385863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PMB 201",
            "address_2": "20162 HWY 18, STE G",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92307",
            "telephone_number": "760-240-9896",
            "fax_number": "760-240-9876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15448 MONDAMON RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923074557",
            "telephone_number": "760-240-9896",
            "fax_number": "760-240-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DESERT HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "FACILITY MANAGER",
        "authorized_official_telephone_number": "760-240-9896",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.