1780533117 NPI number — HAVEN DETOX OPERATING SUBSIDIARY, LLC

NPI Number: 1780533117
Health Care Provider/Practitioner: HAVEN DETOX OPERATING SUBSIDIARY, LLC

NPI Number : 1780533117 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780533117",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HAVEN DETOX OPERATING SUBSIDIARY, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2925 10TH AVE N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM SPRINGS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33461-3000",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1325 N HAVERHILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST PALM BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33417-5914",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-361-9115",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/27/2026",
    "LastUpdateDate": "02/24/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MOORE",
    "AuthorizedOfficialFirstName": "DANIEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "AUTHORIZED OFFICIAL",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "305-361-9115",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "324500000X",
          "TaxonomyName": "Substance Abuse Rehabilitation Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "273R00000X",
          "TaxonomyName": "Psychiatric Hospital Unit",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "323P00000X",
          "TaxonomyName": "Psychiatric Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320800000X",
          "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "283Q00000X",
          "TaxonomyName": "Psychiatric Hospital",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}