Haven of Lakeside, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HAVEN OF LAKESIDE, LLC

Doing business as

Haven Health Lakeside

Practice address

3401 Lockwood Dr
Lakeside, AZ 85929-5613

Phone

(801) 296-5100

NPI assigned

Nov 28, 2014

Last updated

Jan 23, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

HAVEN HEALTH GROUP LLCAs reported in NPPES

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

Authorized official

Name

Brett Robertson

Title

Ceo

Phone

(480) 935-4300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Haven Health Lakeside Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447657994. Details of each certification follow.

• CCN 035277 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 035277

Legal name

HAVEN OF LAKESIDE LLC

Doing business as

HAVEN HEALTH LAKESIDE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Nov 2, 2010

Last certification

Jun 6, 2024

Beds

112

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Health Group Management

Organization structure

LLCProprietary

Incorporated

Nov 17, 2014 in AZ

Enrollment address

3401 Lockwood Dr
Lakeside, AZ 85929-5613

Nursing home name

HAVEN OF LAKESIDE

Affiliated entity

HAVEN HEALTH

Listed as

Haven of LakesideCCN 035277 · All quality measures

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

3 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Nov 2, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

11296.7 residents per day on average

Chain

Haven Health20 facilities in the chain

Penalties (3 years)

1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Part of

Haven Health Group LLC

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.

Owners & managing parties with NPI records 1

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

• Randolph A Clark, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1568456036

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 30

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

• Haven Health Green Valley LLC

  • Skilled Nursing Facility
  • Green Valley, AZ
  • NPI 1730829441

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven Health Prescott LLC

  • Skilled Nursing Facility
  • Prescott, AZ
  • NPI 1588304299

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven Health Sky Harbor LLC

  • Skilled Nursing Facility
  • Phoenix, AZ
  • NPI 1780381558

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Camp Verde, LLC

  • Skilled Nursing Facility
  • Camp Verde, AZ
  • NPI 1104163435

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Cottonwood, LLC

  • Skilled Nursing Facility
  • Cottonwood, AZ
  • NPI 1679810915

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Douglas, LLC

  • Skilled Nursing Facility
  • Douglas, AZ
  • NPI 1073850319

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Flagstaff, LLC

  • Skilled Nursing Facility
  • Flagstaff, AZ
  • NPI 1588901839

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Globe, LLC

  • Skilled Nursing Facility
  • Globe, AZ
  • NPI 1467868075

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Lake Havasu, LLC

  dba Haven of Lake Havasu

  • Skilled Nursing Facility
  • Lake Havasu City, AZ
  • NPI 1366978603

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Phoenix, LLC

  • Skilled Nursing Facility
  • Phoenix, AZ
  • NPI 1215383237

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Safford, LLC

  • Skilled Nursing Facility
  • Safford, AZ
  • NPI 1568709814

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership
• Haven of Saguaro Valley, LLC

  dba Haven of Saguaro Valley

  • Skilled Nursing Facility
  • Tucson, AZ
  • NPI 1346805249

  Haven Health Group LLC, Health Group Management LLC

  CMS ownership

Practitioners 3

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.

• Randolph A Clark, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1568456036
  NPD (past)
• Neeraj Vij, M.D.

  • Hospitalist Physician
  • Cottonwood, AZ
  • NPI 1528054921
  NPD (past)
• David Keebok Warren, M.D.

  • Hospitalist Physician
  • Mesa, AZ
  • NPI 1487947180
  NPD (past)

Affiliated clinicians 3

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

• Randolph A Clark, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1568456036

  Nursing home

  Care Compare affiliation
• Neeraj Vij, M.D.

  • Hospitalist Physician
  • Cottonwood, AZ
  • NPI 1528054921

  Nursing home

  Care Compare affiliation
• David Keebok Warren, M.D.

  • Hospitalist Physician
  • Mesa, AZ
  • NPI 1487947180

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1417132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769126400000",
    "number": "1447657994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 LOCKWOOD DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295613",
            "telephone_number": "801-296-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 LOCKWOOD DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295613",
            "telephone_number": "801-296-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN OF LAKESIDE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN HEALTH GROUP LLC",
        "enumeration_date": "2014-11-28",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "BRETT",
        "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": "048299",
            "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": [
        {
            "organization_name": "Haven Health Lakeside",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Haven Health Lakeside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hall Family Practice PLLC
• Hugh Ryan Hall, DPM
• Karen Olsen Hall, BS RD
• Nanette Hall, FNP
• Jacqueline Susan Harte, L.AC
• Mary Katherine Hegarty, PT
• Kathleen Elizabeth Heiser, SLPA
• High Pines Urology PC
• Home Health Show Low, LLC (Haven Home Health Care)
• Honor Family Healthcare, LLC

• Skilled Nursing Facility in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.