NPIMap

Organization Active NPI

Haven of Hope, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Watsonville, CA
National Provider Identifier
1619466489
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
445201743 Issued in CA
Legal business name
HAVEN OF HOPE, INC.
Practice address
107 Pauline Dr
Watsonville, CA 95076-1063
Phone
(831) 425-3010
Fax
(831) 426-6348
NPI assigned
May 7, 2018
Organization subpart
Yes
Parent organization
HAVEN OF HOPE, INC - HALCYONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Authorized official

Name
Ms. Davina Rene Polanco, MS, CTRS
Title
Executive Director
Phone
(831) 345-2238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 445201743 CA Primary

Addresses

Primary practice location

107 Pauline Dr
Watsonville, CA 95076-1063

Mailing address

PO Box 610
Aptos, CA 95001-0610
Phone (831) 345-2238

Other names 1

  • Haven of Hope, Inc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Haven of Hope Inc3 organizations share this tax ID, including this one
Part of
Haven of Hope Inc

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525651200000",
    "number": "1619466489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610",
            "city": "APTOS",
            "state": "CA",
            "postal_code": "950010610",
            "telephone_number": "831-345-2238",
            "fax_number": "831-426-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 PAULINE DR",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950761063",
            "telephone_number": "831-425-3010",
            "fax_number": "831-426-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN OF HOPE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN OF HOPE, INC - HALCYON",
        "enumeration_date": "2018-05-07",
        "last_updated": "2018-05-07",
        "status": "A",
        "authorized_official_last_name": "POLANCO",
        "authorized_official_first_name": "DAVINA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "831-345-2238",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, CTRS"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": "445201743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haven of Hope, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Haven of Hope, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Watsonville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; 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.