Provider Demographics
NPI:1275716896
Name:HAVEN BEHAVIORAL SERVICES OF PHOENIX, LLC
Entity type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF PHOENIX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-0022
Mailing Address - Street 1:3102 W END AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1324
Mailing Address - Country:US
Mailing Address - Phone:615-398-8800
Mailing Address - Fax:615-982-9829
Practice Address - Street 1:1201 S 7TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3913
Practice Address - Country:US
Practice Address - Phone:623-236-2000
Practice Address - Fax:623-236-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ417059Medicaid
AZZ136159OtherMEDICARE B
AZ034020Medicare Oscar/Certification