MEDICARE: THE HAVEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	16103	UT

General Provider Information

NPI Number	:	1043515364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HAVEN

Provider Business Mailing Address
First Line	:	1450 SOUTH WEST TEMPLE
Second Line	:	APT F 304
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-5203
Country	:	US
Telephone Number	:	801-577-8842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 S WEST TEMPLE
Second Line	:	APT F 304
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-5203
Country	:	US
Telephone Number	:	801-577-8842
Fax Number	:

Authorized Official
Title or Position	:	CASE MANAGER
Name	:	HEATHER JOY CHASE
Credential	:	LSAC
Telephone Number	:	801-533-0070

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	01/18/2011

Similar Medicare Providers

1912865809 — JACKIE ANNE NOVAK RD
Practice Location Address:

8388 COURT AVE STE 202
ELLICOTT CITY, MD
21043-5203

Practice Phone: 443-355-7021
Practice Fax:

1528163391 — NORTHWEST INCORPORATED
Practice Location Address:

3233 NW 10TH ST
OKLAHOMA CITY, OK
73107-5203

Practice Phone: 405-943-8366
Practice Fax: 405-488-0100

1104974252 — LORNA JANE LICSW
Practice Location Address:

5203 CENTER BLVD APT 2706
LONG ISLAND CITY, NY
11101-6672

Practice Phone: 173-653-8376
Practice Fax: 187-868-7147

1972771277 — MS. ANNETTE DAVENPORT MS, LPC
Practice Location Address:

1341 NW 105TH TER
OKLAHOMA CITY, OK
73114-5203

Practice Phone: 405-306-9405
Practice Fax:

1821413857 — MR. JOHNY ABRAHAM FNP
Practice Location Address:

1249 DEER RIDGE DR
LEAGUE CITY, TX
77573-5203

Practice Phone: 281-332-8163
Practice Fax:

1194201806 — ERIKA ALLISON DAVIS SHADE MCMHC, LPC CANDIATE
Practice Location Address:

1613 SE 66TH ST
OKLAHOMA CITY, OK
73149-5203

Practice Phone: 405-616-3366
Practice Fax:

Directions to “THE HAVEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.