Provider Demographics
NPI:1770299638
Name:ELVA'S HAVEN LLC
Entity type:Organization
Organization Name:ELVA'S HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-498-7092
Mailing Address - Street 1:3487 W COLONY CV
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4570
Mailing Address - Country:US
Mailing Address - Phone:808-498-7092
Mailing Address - Fax:
Practice Address - Street 1:3487 W COLONY CV
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4570
Practice Address - Country:US
Practice Address - Phone:808-498-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities