MEDICARE: HAVEN HARMONY 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760245294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN HARMONY LLC

Provider Business Mailing Address
First Line	:	9706 EVERGREEN AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1534
Country	:	US
Telephone Number	:	612-807-2945
Fax Number	:

Provider Business Practice Location Address
First Line	:	9706 EVERGREEN AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1534
Country	:	US
Telephone Number	:	612-807-2945
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUNDUS MOHAMED
Credential	:
Telephone Number	:	612-807-2945

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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Directions to “HAVEN HARMONY LLC ” Practice Location

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