Provider Demographics
NPI:1154905305
Name:VALLEY HAVEN ADULT DAY SERVICES
Entity type:Organization
Organization Name:VALLEY HAVEN ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLODIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-733-9459
Mailing Address - Street 1:2800 HARRIS GRADE RD
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2211
Mailing Address - Country:US
Mailing Address - Phone:805-733-9459
Mailing Address - Fax:
Practice Address - Street 1:2800 HARRIS GRADE RD
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2211
Practice Address - Country:US
Practice Address - Phone:805-733-9459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care