Healthcare Provider Details

I. General information

NPI: 1982983177
Provider Name (Legal Business Name): HAVEN HOME FOR GIRLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 HIGH COUNTRY DR
OREM UT
84097-2369
US

IV. Provider business mailing address

PO BOX 728
SPANISH FORK UT
84660-0728
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-4632
  • Fax: 801-850-9354
Mailing address:
  • Phone: 801-224-4632
  • Fax: 801-850-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MYRNA DALTON
Title or Position: EXEC. DIR.
Credential:
Phone: 801-494-7773