Healthcare Provider Details

I. General information

NPI: 1265824858
Provider Name (Legal Business Name): HEALTH HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 NW 5TH AVE
OKEECHOBEE FL
34972-2568
US

IV. Provider business mailing address

308 NW 5TH AVE
OKEECHOBEE FL
34972-2568
US

V. Phone/Fax

Practice location:
  • Phone: 863-261-8354
  • Fax: 786-221-4107
Mailing address:
  • Phone: 863-261-8354
  • Fax: 863-638-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME111621
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD ASIM NISAR
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 516-640-6937