Provider Demographics
NPI:1912495441
Name:HAVEN OF HOPE, INC.
Entity type:Organization
Organization Name:HAVEN OF HOPE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVINA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-425-3010
Mailing Address - Street 1:262 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4413
Mailing Address - Country:US
Mailing Address - Phone:831-345-2238
Mailing Address - Fax:831-426-6348
Practice Address - Street 1:262 NORTH AVE
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4413
Practice Address - Country:US
Practice Address - Phone:831-425-3010
Practice Address - Fax:831-426-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid