Provider Demographics
NPI:1467919399
Name:UNICORN HAVEN LLC
Entity Type:Organization
Organization Name:UNICORN HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:HLADEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-909-3223
Mailing Address - Street 1:1445 E GUADALUPE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3953
Mailing Address - Country:US
Mailing Address - Phone:602-909-3223
Mailing Address - Fax:
Practice Address - Street 1:1445 E GUADALUPE RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3953
Practice Address - Country:US
Practice Address - Phone:602-909-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
465505OtherAHCCCS