Provider Demographics
NPI:1659413847
Name:SOLACIUM NEW HAVEN, LLC
Entity Type:Organization
Organization Name:SOLACIUM NEW HAVEN, LLC
Other - Org Name:NEW HAVEN RESIDENTIAL TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-829-4060
Mailing Address - Street 1:5500 MING AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4631
Mailing Address - Country:US
Mailing Address - Phone:661-622-4132
Mailing Address - Fax:801-798-3592
Practice Address - Street 1:2172 E 7200 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-9340
Practice Address - Country:US
Practice Address - Phone:801-794-1218
Practice Address - Fax:801-798-3592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLACIUM-NEW HAVEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322D00000X
UT11317323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children