Healthcare Provider Details

I. General information

NPI: 1902755341
Provider Name (Legal Business Name): HAVEN DETOX LR OPERATING SUBSIDIARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 STAGECOACH RD
LITTLE ROCK AR
72204-8515
US

IV. Provider business mailing address

2925 10TH AVE N
PALM SPRINGS FL
33461-3000
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-0903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TARA GURNEY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 561-517-3400