Provider Demographics
NPI:1770853921
Name:CHAPL HAVEN WEST, INC.
Entity Type:Organization
Organization Name:CHAPL HAVEN WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STORZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-397-1714
Mailing Address - Street 1:1040 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1740
Mailing Address - Country:US
Mailing Address - Phone:203-397-1714
Mailing Address - Fax:
Practice Address - Street 1:1701 N PARK AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3584
Practice Address - Country:US
Practice Address - Phone:520-624-9378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities