Provider Demographics
NPI:1477616068
Name:HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:HAVEN CHEMICAL HEALTH SYSTEMS, LLC
Other - Org Name:THE HAVEN IN CLOQUET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVEN
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 1:1003 CLOQUET AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1694
Practice Address - Country:US
Practice Address - Phone:218-879-5545
Practice Address - Fax:218-879-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1027938-2-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty