MEDICARE: HAVENWOOD ACADEMY

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	320800000X	Mental Illness Community Based Residential Treatment Facility	15732, 15733	UT
2	324500000X	Substance Abuse Rehabilitation Facility	15732, 15733	UT
3	323P00000X	Psychiatric Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	425443	OTHER	JOINT COMMISSION ON THE ACCREDITATION OF HEATHCARE ORGANIZATIONS JCAHO

General Provider Information

NPI Number	:	1528116746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVENWOOD ACADEMY

Provider Business Mailing Address
First Line	:	2261 MARKET ST STE 5382
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-1612
Country	:	US
Telephone Number	:	435-586-2500
Fax Number	:	435-359-5213

Provider Business Practice Location Address
First Line	:	8097 W 2000 S
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720
Country	:	US
Telephone Number	:	435-586-2500
Fax Number	:	435-359-5213

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN HOFELING
Credential	:
Telephone Number	:	435-586-2500

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	04/08/2026

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Directions to “HAVENWOOD ACADEMY ” Practice Location

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