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General NPI Number Information
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NPI Number | 1265824858
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Entity Type | Organization
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Legal Business Name | HEALTH HAVEN LLC
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 308 NW 5TH AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2568
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Country | US
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Telephone | 863-261-8354
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Fax | 786-221-4107
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Provider Business Mailing Address
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Address Line | 308 NW 5TH AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2568
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Country | US
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Telephone | 863-261-8354
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Fax | 863-638-5637
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MOHAMMAD ASIM NISAR
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Credential |
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Telephone | 516-640-6937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME111621
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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