Happy Haven Az LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

HAPPY HAVEN AZ LLC

Practice address

1110 W Hadley St
Phoenix, AZ 85007-3610

Phone

(857) 200-7660

Fax

(602) 675-1847

NPI assigned

Mar 16, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Gael Karomba

Title

Ceo

Phone

(857) 200-7660

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1043846561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W HADLEY ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073610",
            "telephone_number": "857-200-7660",
            "fax_number": "602-675-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W HADLEY ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073610",
            "telephone_number": "857-200-7660",
            "fax_number": "602-675-1847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAPPY HAVEN AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "KAROMBA",
        "authorized_official_first_name": "GAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "857-200-7660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BH6042",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.