Provider Demographics
NPI:1205439569
Name:HAVEN CHEMICAL HEALTH
Entity type:Organization
Organization Name:HAVEN CHEMICAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FRAZERJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-734-9633
Mailing Address - Street 1:2042 WOODDALE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4421
Mailing Address - Country:US
Mailing Address - Phone:651-734-9633
Mailing Address - Fax:651-734-9633
Practice Address - Street 1:950 9TH AVE
Practice Address - Street 2:
Practice Address - City:ST PAUL PARK
Practice Address - State:MN
Practice Address - Zip Code:55071-1436
Practice Address - Country:US
Practice Address - Phone:651-734-9633
Practice Address - Fax:651-734-9533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN CHEMICAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty