Provider Demographics
NPI:1104082114
Name:HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Entity type:Organization
Organization Name:HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-734-9633
Mailing Address - Street 1:2042 WOODDALE DR
Mailing Address - Street 2:SUITE #220
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2981
Mailing Address - Country:US
Mailing Address - Phone:651-734-9633
Mailing Address - Fax:
Practice Address - Street 1:22355 ALBATROSS CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-9537
Practice Address - Country:US
Practice Address - Phone:651-463-2608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility