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General NPI Number Information
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NPI Number | 1538774393
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Entity Type | Organization
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Legal Business Name | PROSPERITY HAVEN, LLC
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 9600 OLD STATE RD
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City | CHARDON
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State | OH
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Zip | 44024-9260
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Country | US
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Telephone | 440-285-2762
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 OLD STATE RD
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City | CHARDON
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State | OH
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Zip | 44024-9260
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Country | US
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Telephone | 440-285-2762
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEIR KASNETT
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Credential |
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Telephone | 216-372-6643
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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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