MEDICARE: SOLACIUM NEW HAVEN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1659413847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACIUM NEW HAVEN, LLC

Provider Business Mailing Address
First Line	:	5500 MING AVE STE 410
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-4631
Country	:	US
Telephone Number	:	661-622-4132
Fax Number	:	801-798-3592

Provider Business Practice Location Address
First Line	:	3082 E 700 S
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-5841
Country	:	US
Telephone Number	:	801-794-1218
Fax Number	:	801-798-3592

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SHARNELL SPENCER
Credential	:
Telephone Number	:	661-239-6923

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	01/28/2026

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