MEDICARE: HAVEN DETOX

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	273R00000X	Psychiatric Hospital Unit
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	323P00000X	Psychiatric Residential Treatment Facility
4	324500000X	Substance Abuse Rehabilitation Facility	1550AD274001	FL
5	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1457762809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN DETOX

Provider Business Mailing Address
First Line	:	1325 NORTH HAVERHILL ROAD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417
Country	:	US
Telephone Number	:	561-635-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 N HAVERHILL RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5914
Country	:	US
Telephone Number	:	561-635-2400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. KIRILL VESSELOV
Credential	:
Telephone Number	:	561-635-2400

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	02/28/2025

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Directions to “HAVEN DETOX ” Practice Location

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