MEDICARE: HAVEN ARIZONA, LLC

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	283Q00000X	Psychiatric Hospital
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1487436796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN ARIZONA, LLC

Provider Business Mailing Address
First Line	:	2925 10TH AVE N
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 S PROSPEROUS PL
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-6403
Country	:	US
Telephone Number	:	561-635-2400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIRILL VESSELOV
Credential	:
Telephone Number	:	561-396-5849

Provider Enumeration Date	:	10/20/2023
Last Update Date	:	02/19/2025

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Directions to “HAVEN ARIZONA, LLC ” Practice Location

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