Provider Demographics
NPI:1689186769
Name:PROSPERITY HAVEN, LLC
Entity Type:Organization
Organization Name:PROSPERITY HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KASNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-372-6643
Mailing Address - Street 1:9600 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9260
Mailing Address - Country:US
Mailing Address - Phone:440-285-2762
Mailing Address - Fax:
Practice Address - Street 1:9600 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9260
Practice Address - Country:US
Practice Address - Phone:859-652-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0312566Medicaid