Healing Haven Mental Health

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

HEALING HAVEN MENTAL HEALTH

Practice address

1519 Washington Ave
San Jacinto, CA 92583-6075

Phone

(650) 559-4850

NPI assigned

Oct 22, 2025

Organization subpart

No

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

Authorized official

Name

Kenyada Marie WagonerNPI 1760172688

Title

Ceo

Phone

(650) 559-4850

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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

• Kenyada Marie Wagoner, LCSW

  • Clinical Social Worker
  • Riverside, CA
  • NPI 1760172688
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1761091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1922975978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E ESPLANADE AVE UNIT 89",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925835102",
            "telephone_number": "951-214-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 WASHINGTON AVE",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "925836075",
            "telephone_number": "650-559-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING HAVEN MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-22",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "KENYADA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-559-4850"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Hart
• Mera Hashwani, PT, DPT
• Lorri Ann Hays
• Jenessa Headley
• Healing Haven Licensed Clinical
• Healthcare Management Systems, Inc
• Healthy Life Nemt LLC
• Jaime L Helton, RN
• Paula Henke
• Rosita D Hermosillo

• Clinical Social Worker in San Jacinto, CA
• Providers in San Jacinto, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.