NPIMap

Organization Active NPI

Haven of Cottonwood, LLC

  • Skilled Nursing Facility
  • Cottonwood, AZ
National Provider Identifier
1679810915
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCI-2707 Issued in AZ
Legal business name
HAVEN OF COTTONWOOD, LLC
Practice address
197 S Willard St
Cottonwood, AZ 86326-4123
Phone
(928) 634-5548
Fax
(928) 634-9602
NPI assigned
Jan 7, 2013
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
President
Phone
(480) 935-4300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NCI-2707 AZ Primary
Skilled Nursing Facility 314000000X

Addresses

Primary practice location

197 S Willard St
Cottonwood, AZ 86326-4123

Mailing address

197 S Willard St
Cottonwood, AZ 86326-4123
Phone (928) 634-5548

Other identifiers 1

IdentifierTypeStateIssuer
813280MedicaidAZ

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.
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
O20130326000316 AZ Part A Provider - Skilled Nursing Facility 5698910537 Practice locations: Cottonwood, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679810915. Details of each certification follow.

Skilled nursing facility certification: CCN 035093

Legal name
HAVEN OF COTTONWOOD LLC
Doing business as
HEALTH GROUP MANAGEMENT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 22, 1984
Last certification
Apr 11, 2024
Beds
80
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Haven Health Group
Organization structure
LLCProprietary
Enrollment address
197 S Willard St
Cottonwood, AZ 86326-4123
Nursing home name
HAVEN OF COTTONWOOD
Affiliated entity
HAVEN HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Haven of CottonwoodCCN 035093 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 22, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8065.6 residents per day on average
Chain
Haven Health20 facilities in the chain

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
03D0534161Haven at Cottonwood197 S Willard St, Cottonwood, AZ 86326Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Part of
Haven Health Group LLC

Ownership & related parties

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.

NameRoleSinceShare
Christian R West Individual 5% Or Greater Direct Ownership InterestManager Feb 1, 2013 6.4%
Operational/Managerial Control Jan 22, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 6.4%
Neeraj K Vij Individual Operational/Managerial Control Mar 15, 2021
Adp of the SNF Mar 1, 2021
Haven Real Estate Partners, LLC Organization, Laguna Beach, CA Created for acquisition 5% Or Greater Mortgage Interest Feb 1, 2013 100%
Adp of the SNF Dec 9, 2024
Ronald Hammer Individual Operational/Managerial Control Oct 28, 2024
Adp of the SNF Oct 28, 2024
Haven Arizona Real Estate, LLC Organization, Laguna Beach, CA Created for acquisition, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 1, 2013 100%
Adp of the SNF Dec 9, 2024
Cody Nielsen Individual Operational/Managerial Control Nov 26, 2024
Adp of the SNF Nov 26, 2024
Stephen Samuelian Individual 5% Or Greater Direct Ownership InterestManager Feb 1, 2013 36.73%
Operational/Managerial Control Jan 22, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 36.73%
Robert Samuelian Individual 5% Or Greater Direct Ownership InterestManager Feb 1, 2013 20.13%
Operational/Managerial Control Jan 22, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 20.13%
Spencer R Samuelian Individual 5% Or Greater Direct Ownership InterestCoo Feb 1, 2013 25.21%
Operational/Managerial Control Jan 22, 2025
Adp of the SNF Jan 22, 2025
Direct Ownership Interest Feb 1, 2013 25.21%
Stephanie Espinosa Individual Operational/Managerial Control Oct 14, 2024
Adp of the SNF Oct 14, 2024
Haven Cottonwood Real Estate LLC Organization, Laguna Beach, CA Created for acquisition, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 1, 2013 100%
Adp of the SNF Dec 3, 2024
Jason J Seastrand Individual Operational/Managerial Control Feb 1, 2013
Adp of the SNF Feb 1, 2013
Direct Ownership Interest Feb 1, 2013 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 InterestManager/President/Ceo Feb 1, 2013 7.61%
Corporate OfficerPresident/Ceo/Manager Feb 1, 2013 7.61%
Adp of the SNF Dec 5, 2024
Haven Health Group LLC Organization, Laguna Beach, CA Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2013 100%
Stock Longhurst Individual Operational/Managerial Control Nov 15, 2020
Adp of the SNF Nov 15, 2020
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 1

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 1

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 2

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": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1679810915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 S WILLARD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264123",
            "telephone_number": "928-634-5548",
            "fax_number": "928-634-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 S WILLARD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264123",
            "telephone_number": "928-634-5548",
            "fax_number": "928-634-9602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN OF COTTONWOOD, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN HEALTH GROUP LLC",
        "enumeration_date": "2013-01-07",
        "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": "PRESIDENT",
        "authorized_official_telephone_number": "480-935-4300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-2707",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "813280",
            "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"
        },
        {
            "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": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "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 Cottonwood, AZ

Sources for this page

Verify at the official NPI Registry.