Healthcare Provider Details

I. General information

NPI: 1265363014
Provider Name (Legal Business Name): HAVEN CREST OPERATIONS CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2602 S ENSENADA WAY
AURORA CO
80013-7690
US

IV. Provider business mailing address

2602 S ENSENADA WAY
AURORA CO
80013-7690
US

V. Phone/Fax

Practice location:
  • Phone: 720-450-9760
  • Fax:
Mailing address:
  • Phone: 720-450-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RACHEL MARIE EVERETT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 573-452-3214