Provider Demographics
NPI:1093045551
Name:HAVEN ROAD RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:HAVEN ROAD RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-0065
Mailing Address - Street 1:16403 HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6400
Mailing Address - Country:US
Mailing Address - Phone:320-632-0065
Mailing Address - Fax:320-632-0920
Practice Address - Street 1:115 3RD ST S
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1332
Practice Address - Country:US
Practice Address - Phone:320-632-0065
Practice Address - Fax:320-632-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1055432101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty