Provider Demographics
NPI:1528116746
Name:HAVENWOOD ACADEMY
Entity type:Organization
Organization Name:HAVENWOOD ACADEMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-586-2500
Mailing Address - Street 1:2261 MARKET ST STE 5382
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1612
Mailing Address - Country:US
Mailing Address - Phone:435-586-2500
Mailing Address - Fax:435-359-5213
Practice Address - Street 1:8097 W 2000 S
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-586-2500
Practice Address - Fax:435-359-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15732, 15733320800000X, 324500000X
323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509045Medicaid
UT788007789018Medicaid
425443OtherJOINT COMMISSION ON THE ACCREDITATION OF HEATHCARE ORGANIZATIONS JCAHO