Provider Demographics
NPI:1255170858
Name:HAVEN MANOR LLC
Entity type:Organization
Organization Name:HAVEN MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGANGA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:623-203-0771
Mailing Address - Street 1:13594 W POST DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5405
Mailing Address - Country:US
Mailing Address - Phone:623-203-0771
Mailing Address - Fax:
Practice Address - Street 1:13594 W POST DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5405
Practice Address - Country:US
Practice Address - Phone:623-203-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness