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General NPI Number Information
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NPI Number | 1689356776
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Entity Type | Organization
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Legal Business Name | HAVEN ONE-EIGHTY LLC
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 15213 N 143RD AVENUE 8738 W CHOLLA
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City | PEORIA
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State | AZ
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Zip | 85345
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Country | US
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Telephone | 602-358-9175
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Fax |
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Provider Business Mailing Address
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Address Line | 15213 N 143RD AVE
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City | SURPRISE
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State | AZ
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Zip | 85379-8542
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Country | US
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Telephone | 160-235-8917
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ANALIZA DE PEDRO
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Credential |
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Telephone | 602-358-9175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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