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NPI Code Detail

MEDICARE: HAVEN DETOX OPERATING SUBSIDIARY, LLC

MEDICARE: HAVEN DETOX OPERATING SUBSIDIARY, 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
1324500000XSubstance Abuse Rehabilitation Facility
2273R00000XPsychiatric Hospital Unit
3323P00000XPsychiatric Residential Treatment Facility
4320800000XMental Illness Community Based Residential Treatment Facility
5283Q00000XPsychiatric Hospital

General Provider Information

NPI Number : 1780533117
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAVEN DETOX OPERATING SUBSIDIARY, LLC
Provider Business Mailing Address
First Line : 2925 10TH AVE N
Second Line :
City : PALM SPRINGS
State : FL
Zip : 33461-3000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1325 N HAVERHILL RD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33417-5914
Country : US
Telephone Number : 305-361-9115
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DANIEL MOORE
Credential :
Telephone Number : 305-361-9115
Provider Enumeration Date : 01/27/2026
Last Update Date : 02/24/2026

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