Provider Demographics
NPI:1689356776
Name:HAVEN ONE-EIGHTY LLC
Entity Type:Organization
Organization Name:HAVEN ONE-EIGHTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANALIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-358-9175
Mailing Address - Street 1:15213 N 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8542
Mailing Address - Country:US
Mailing Address - Phone:160-235-8917
Mailing Address - Fax:
Practice Address - Street 1:15213 N 143RD AVENUE
Practice Address - Street 2:8738 W CHOLLA
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:602-358-9175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder