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General NPI Number Information
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NPI Number | 1407403983
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Entity Type | Organization
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Legal Business Name | HAVEN RECOVERY LLC
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 1474 W 2100 N
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-9508
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Country | US
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Telephone | 801-400-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 11295 N TAMARACK DR
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City | HIGHLAND
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State | UT
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Zip | 84003-9596
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Country | US
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Telephone | 801-400-7176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IVY MICHELLE O'BRIEN
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Credential |
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Telephone | 801-400-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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