Healthcare Provider Details

I. General information

NPI: 1174446702
Provider Name (Legal Business Name): HAVEN BEHAVIORAL SERVICES OF PHOENIX WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 S 9TH AVE
PHOENIX AZ
85007-3904
US

IV. Provider business mailing address

3905 HEDGCOXE RD UNIT 250249
PLANO TX
75025-0840
US

V. Phone/Fax

Practice location:
  • Phone: 972-464-0022
  • Fax:
Mailing address:
  • Phone: 972-464-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: LAURA F. TARANTINO
Title or Position: EVP
Credential:
Phone: 972-464-0022