Healthcare Provider Details

I. General information

NPI: 1104082114
Provider Name (Legal Business Name): HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22355 ALBATROSS CIR
FARMINGTON MN
55024-9537
US

IV. Provider business mailing address

2042 WOODDALE DR SUITE #220
WOODBURY MN
55125-2981
US

V. Phone/Fax

Practice location:
  • Phone: 651-463-2608
  • Fax:
Mailing address:
  • Phone: 651-734-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: ROBERT L HAVEN
Title or Position: PRESIDENT
Credential:
Phone: 651-734-9633