=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578368601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVEN BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1440 ROCKSIDE RD STE 314
-----------------------------------------------------
City | PARMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44134-2749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-859-0322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1064 MORNING GLORY DR
-----------------------------------------------------
City | MACEDONIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44056-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-981-2452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN
-----------------------------------------------------
Name | SARAH AMO-MENSAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-981-2452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------