Healthcare Provider Details

I. General information

NPI: 1447848676
Provider Name (Legal Business Name): HATCH HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S LINDSAY RD STE 101
GILBERT AZ
85296-2966
US

IV. Provider business mailing address

1009 E GAIL DR
GILBERT AZ
85296-9779
US

V. Phone/Fax

Practice location:
  • Phone: 480-815-6490
  • Fax:
Mailing address:
  • Phone: 480-815-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN LEE NORBUT
Title or Position: MANAGER
Credential:
Phone: 480-815-6490