HAVEN OF DOUGLAS, LLC
NPI 1073850319
Skilled Nursing Facility in Douglas, AZ

Active since January 07, 2013CLIA 03D0874124 · Waiver
1400 N SAN ANTONIO AVE, DOUGLAS, AZ 85607(520) 364-7937(520) 805-9146 Get Directions Write a Review

NPPES record last updated: May 22, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 22, 2025, Dec 31, 2024, Dec 27, 2024 and 5 more (8 updates tracked since 2017).

About Haven Of Douglas, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAVEN OF DOUGLAS, LLC (NPI 1073850319) is a healthcare organization registered as a skilled nursing facility in Douglas, Arizona and active in the NPI registry since January 2013. The organization holds a CLIA Waiver certificate valid through August 3, 2027 and lists Brett P Robertson, President, as its authorized official.

NPPES Registry Identity

NPI1073850319
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHAVEN OF DOUGLAS, LLC
Location Address1400 N SAN ANTONIO AVEDouglas, AZ 85607-2434
Mailing Address1400 N San Antonio AveDouglas, AZ 85607-2434 · (520) 364-7937 · Fax (520) 805-9146
Fax(520) 805-9146
Organization SubpartYesParent: Haven Health Group Arizona, Llc
Authorized OfficialBrett P RobertsonPresident · (480) 935-4300
Enumeration DateJanuary 7, 2013
Last NPPES UpdateMay 22, 20258 updates tracked since enumeration
NPPES CertifiedMay 22, 2025
NPI 1073850319 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in AZ · NCI-2708
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
1400 N SAN ANTONIO AVE, Douglas, AZ 85607

Other Identifiers 1

Medicaid813298AZ

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D0874124

Haven Of Douglas, LLC · Douglas, AZ
Active · expires Aug 3, 2027
CLIA Number03D0874124
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateAugust 4, 2025
Certificate Expiration DateAugust 3, 2027
Laboratory DirectorBilley G. Peralta
Laboratory Phone(520) 364-7937
Laboratory LocationHaven Of Douglas, LLC1400 N San Antonio Ave, Douglas, AZ 85607
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
1400 N SAN ANTONIO AVE
DOUGLAS, AZ 85607
Physical Therapist
1400 N SAN ANTONIO AVE
DOUGLAS, AZ 85607
Skilled Nursing Facility
1400 N SAN ANTONIO AVE
DOUGLAS, AZ 85607

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Haven Of Douglas, LLC's NPI number?

The NPI number for Haven Of Douglas, LLC is 1073850319. It was assigned to this organization in the NPPES registry on January 7, 2013.

Where is Haven Of Douglas, LLC located?

Haven Of Douglas, LLC is located at 1400 N San Antonio Ave, Douglas, AZ 85607. The listed phone number is (520) 364-7937.

What is Haven Of Douglas, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Haven Of Douglas, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D0874124) is associated with this NPI, valid through August 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Haven Of Douglas, LLC accept?

Health plans from Ambetter from Arizona Complete Health and Blue Cross Blue Shield of Arizona list Haven Of Douglas, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Haven Of Douglas, LLC was last updated on May 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.