NPIMap

Organization Active NPI

Haven Skilled Services, LLC

  • Home Health Agency
  • San Diego, TX
National Provider Identifier
1669778551
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
HAVEN SKILLED SERVICES, LLC
Practice address
500 S Dr Ee Dunlap St Ste a&B
San Diego, TX 78384-3212
Phone
(361) 279-7159
Fax
(361) 279-7256
NPI assigned
Feb 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Authorized official

Name
Ms. Cynthia Perez
Title
Owner/President
Phone
(361) 279-7159

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X

Addresses

Primary practice location

500 S Dr Ee Dunlap St Ste a&B
San Diego, TX 78384-3212

Mailing address

PO Box 283
San Diego, TX 78384-0283
Phone (361) 279-7159

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120418000043 TX Part A Provider - Home Health Agency 1759542871 Practice locations: San Diego, TX

Home health agency certification: CCN 747748

Legal name
HAVEN SKILLED SERVICES, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 11, 2012
Last certification
Jul 1, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
500 S Dr Ee Dunlap St
Ste a&B
San Diego, TX 78384-3212

Care Compare: Home health agency

Medicare Care Compare
Listed as
Haven Skilled Services LLCCCN 747748 · All quality measures
Ownership
Proprietary
Certified
Sep 11, 2012
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

500 S Dr EE Dunlap St
Ste A
San Diego, TX 78384
Phone (361) 279-7159

500 S Dr EE Dunlap St
Ste Ab
San Diego, TX 78384
Phone (361) 279-7159

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Cynthia Perez Individual 5% Or Greater Direct Ownership Interest Aug 23, 2013 31%
W-2 Managing EmployeeOwner Ceo President Aug 23, 2013
Crystal a Crisp Individual 5% Or Greater Direct Ownership Interest Aug 23, 2013 33%
W-2 Managing EmployeeOwner Board Member Aug 23, 2013 33%
Sandra Garza Individual W-2 Managing EmployeeAlternate Administrator Apr 18, 2026
Jennifer Fehrenkamp Individual 5% Or Greater Direct Ownership InterestAdministrator Aug 23, 2013 5%
W-2 Managing EmployeeAd; Jun 4, 2013
Monica Ann Espinoza Individual W-2 Managing EmployeeAlternate Director of Nursing Adon Jan 31, 2023
Rene M Perez Individual 5% Or Greater Direct Ownership Interest Aug 23, 2013 31%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1297296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1669778551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 283",
            "city": "SAN DIEGO",
            "state": "TX",
            "postal_code": "783840283",
            "telephone_number": "361-279-7159",
            "fax_number": "361-279-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S DR EE DUNLAP ST STE A&B",
            "city": "SAN DIEGO",
            "state": "TX",
            "postal_code": "783843212",
            "telephone_number": "361-279-7159",
            "fax_number": "361-279-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN SKILLED SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-10",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "361-279-7159",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, TX

Sources for this page

Verify at the official NPI Registry.