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General NPI Number Information
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NPI Number | 1982983177
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Entity Type | Organization
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Legal Business Name | HAVEN HOME FOR GIRLS
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 846 HIGH COUNTRY DR
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City | OREM
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State | UT
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Zip | 84097-2369
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Country | US
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Telephone | 801-224-4632
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Fax | 801-850-9354
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | SPANISH FORK
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State | UT
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Zip | 84660-0728
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Country | US
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Telephone | 801-224-4632
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Fax | 801-850-9354
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Authorized Official
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Title or Position | EXEC. DIR.
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Name | MYRNA DALTON
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Credential |
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Telephone | 801-494-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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