| NPI | 1205492568 |
|---|---|
| Doing Business As | MYSTIC HAVEN |
| Entity Type | Organization |
| Authorized Contact | YANNIE TABLIZO Managing Member 702-302-6932 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2019-05-13 |