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General NPI Number Information
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NPI Number | 1386529048
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Entity Type | Organization
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Legal Business Name | HAVENDETOX PR LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | CARR, #2 KM 117.9 INT SOLAR 6 BO. CEIBA BAJA DE AGUADILLA
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 561-461-3791
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 10TH AVE N
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City | PALM SPRINGS
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State | FL
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Zip | 33461-3000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRILL VESSELOV
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Credential |
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Telephone | 561-461-3791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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