Healthcare Provider Details

I. General information

NPI: 1275716896
Provider Name (Legal Business Name): HAVEN BEHAVIORAL SERVICES OF PHOENIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE SUITE 200
PHOENIX AZ
85007-3913
US

IV. Provider business mailing address

3102 W END AVE STE 1000
NASHVILLE TN
37203-1324
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-2000
  • Fax: 623-236-2050
Mailing address:
  • Phone: 615-398-8800
  • Fax: 615-982-9829

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 TARANTINO
Title or Position: EVP
Credential:
Phone: 972-464-0022