Healthcare Provider Details

I. General information

NPI: 1659413847
Provider Name (Legal Business Name): SOLACIUM NEW HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 E 7200 S
SPANISH FORK UT
84660-9340
US

IV. Provider business mailing address

5500 MING AVE STE 410
BAKERSFIELD CA
93309-4631
US

V. Phone/Fax

Practice location:
  • Phone: 801-794-1218
  • Fax: 801-798-3592
Mailing address:
  • Phone: 661-622-4132
  • Fax: 801-798-3592

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: SHARNELL SPENCER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 661-239-6923