Healthcare Provider Details

I. General information

NPI: 1083875660
Provider Name (Legal Business Name): HAVEN BEHAVIORAL SERVICES OF PHOENIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16620 N 40TH ST SUITE I-1
PHOENIX AZ
85032-3348
US

IV. Provider business mailing address

652 W IRIS DR
NASHVILLE TN
37204-3191
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-5845
  • Fax: 602-923-5846
Mailing address:
  • Phone: 615-250-9500
  • Fax: 615-250-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberBH-3156
License Number StateAZ

VIII. Authorized Official

Name: MR. WILLIAM PAGE BARNES
Title or Position: CFO/SECRETARY
Credential:
Phone: 615-250-9091