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General NPI Number Information
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NPI Number | 1457762809
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Entity Type | Organization
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Legal Business Name | HAVEN DETOX
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 1325 N HAVERHILL RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-5914
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Country | US
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Telephone | 561-635-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 NORTH HAVERHILL ROAD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417
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Country | US
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Telephone | 561-635-2400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. KIRILL VESSELOV
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Credential |
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Telephone | 561-635-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1550AD274001
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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