Healthcare Provider Details

I. General information

NPI: 1295898872
Provider Name (Legal Business Name): HAVEN CHEMICAL HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 1ST ST W
WACONIA MN
55387
US

IV. Provider business mailing address

2042 WOODDALE DR SUITE 220
WOODBURY MN
55125-2981
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-6227
  • Fax: 952-442-6228
Mailing address:
  • Phone: 651-734-9633
  • Fax: 651-734-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1015009-2-CDT
License Number StateMN

VIII. Authorized Official

Name: REBECCA HAVEN
Title or Position: CONTRACT MANAGER
Credential:
Phone: 651-734-9633