Provider Demographics
NPI:1073995080
Name:THE HAVEN DETOX CENTER LLC
Entity Type:Organization
Organization Name:THE HAVEN DETOX CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-515-0422
Mailing Address - Street 1:8649 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5812
Mailing Address - Country:US
Mailing Address - Phone:360-515-0422
Mailing Address - Fax:928-708-9620
Practice Address - Street 1:8649 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5812
Practice Address - Country:US
Practice Address - Phone:360-515-0422
Practice Address - Fax:928-708-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF.FS.60577277324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility