Provider Demographics
NPI:1073676672
Name:HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Other - Org Name:THE HAVEN IN SHAKOPEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRZER-JOHN
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:651-734-9533
Practice Address - Street 1:235 FIRST AVENUE EAST
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-496-3366
Practice Address - Fax:952-496-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1009085-2-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty