Haven Detox of New Jersey LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

HAVEN DETOX OF NEW JERSEY LLC

Practice address

6 Collier Dr
Blackwood, NJ 08012-2983

Phone

(561) 635-2400

NPI assigned

Oct 20, 2023

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) 396-5849

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1255113569",
    "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": "6 COLLIER DR",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122983",
            "telephone_number": "561-635-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN DETOX OF NEW JERSEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-396-5849"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelica Harrop, PA-C
• Monique La-Ruth Hart, MSW, LCSW, LICSW
• Tatanisha Hason, APN
• Clarita Hatley, PHARMD
• Haven Detox NJ Operating Subsidiary, LLC
• Shaymaa Shakor Hebatallah
• Helping Hands Caring Hearts
• Destiny Hill, MS, LAC, LCADC
• Dashnay Holmes
• Victoria Horan

• Substance Abuse Rehabilitation Facility in Blackwood, NJ
• Providers in Blackwood, NJ by specialty
• Substance Abuse Rehabilitation Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.