Provider Demographics
NPI:1295898872
Name:HAVEN CHEMICAL HEALTH SYSTEMS
Entity type:Organization
Organization Name:HAVEN CHEMICAL HEALTH SYSTEMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-734-9633
Mailing Address - Street 1:2042 WOODDALE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2981
Mailing Address - Country:US
Mailing Address - Phone:651-734-9633
Mailing Address - Fax:651-734-9533
Practice Address - Street 1:233 1ST ST W
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387
Practice Address - Country:US
Practice Address - Phone:952-442-6227
Practice Address - Fax:952-442-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1015009-2-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty