Sure Haven Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SURE HAVEN INC.

Practice address

2900 Bristol St
Costa Mesa, CA 92626-5981

Phone

(702) 305-9167

Fax

(949) 209-5490

NPI assigned

Nov 28, 2012

Organization subpart

No

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

Authorized official

Name

Steve Fennelly

Title

Ceo

Phone

(702) 305-9167

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545955200000",
    "number": "1942545199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 BRISTOL ST",
            "address_2": "SUITE B202",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 BRISTOL ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265981",
            "telephone_number": "702-305-9167",
            "fax_number": "949-209-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURE HAVEN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2018-12-28",
        "status": "A",
        "authorized_official_last_name": "FENNELLY",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-305-9167"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DHCS",
            "identifier": "300235QP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.