Haven Detox of West Memphis, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

HAVEN DETOX OF WEST MEMPHIS, LLC

Practice address

410 S Avalon St
West Memphis, AR 72301-4183

Phone

(561) 635-2400

NPI assigned

Oct 27, 2023

Last updated

Oct 27, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kirill Vesselov

Title

President

Phone

(561) 635-2400

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1043082555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 10TH AVE N",
            "city": "PALM SPRINGS",
            "state": "FL",
            "postal_code": "334613000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S AVALON ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723014183",
            "telephone_number": "561-635-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN DETOX OF WEST MEMPHIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-27",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-635-2400"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in West Memphis, AR
• Providers in West Memphis, AR by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.