Haven Health Prescott Alf LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

HAVEN HEALTH PRESCOTT ALF LLC

Practice address

860 Dougherty St
Prescott, AZ 86305-1841

Phone

(928) 778-9777

NPI assigned

Mar 30, 2022

Organization subpart

No

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

Authorized official

Name

Brett P Robertson

Title

Ceo

Phone

(480) 935-4300

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1831839547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 DOUGHERTY ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051841",
            "telephone_number": "928-778-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 DOUGHERTY ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051841",
            "telephone_number": "928-778-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN HEALTH PRESCOTT ALF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-30",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-935-4300"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831839547",
            "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": []
}

• Annie Celeste Hart, PA
• Carlena K Hart, APRN,BC
• Patricia Marie Hartnett, PA C
• Thomas Scott Haslam, PA-C
• Yusuf Hassan, M.D.
• Haven Health Prescott LLC
• Latricia Haver, LPC
• Monty A Hawkins, MD
• Mark Hayden, D.D.S.
• Hayes Health, PLLC

• Assisted Living Facility in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; 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.