Haven New England: MH

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

HAVEN NEW ENGLAND: MH

Practice address

1369 Grafton St
Worcester, MA 01604-2737

Phone

(561) 635-2400

NPI assigned

Oct 19, 2023

Organization subpart

Yes

Parent organization

HAVEN DETOX MAAs reported in NPPES

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 2

Addresses

Tax ID family

Haven Detox Ma2 organizations share this tax ID, including this one

Part of

Haven Detox Ma

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Haven Detox Ma

  • Mental Illness Community Based Residential Treatment Facility
  • Worcester, MA
  • NPI 1770159105
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Haven Detox Ma

  • Mental Illness Community Based Residential Treatment Facility
  • Worcester, MA
  • NPI 1770159105
  NPPES parent name

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

{
    "created_epoch": "1697673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1376325720",
    "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": "1369 GRAFTON ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016042737",
            "telephone_number": "561-635-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN NEW ENGLAND: MH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN DETOX MA",
        "enumeration_date": "2023-10-19",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "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": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wai Fung Hau, MD
• Audra L. Hauck, P.A.
• Joshua Haugh, DO
• Haven Detox Ma
• Haven Detox Ma Operating Subsidiary, LLC
• Mali Malka Haver Glazer
• Cathleen Joan Havey, OTA
• Karen A. Hawk, LSW
• Megan Hawkins
• Julia Hawley

• Mental Illness Community Based Residential Treatment Facility in Worcester, MA
• Providers in Worcester, MA by specialty
• Mental Illness Community Based Residential Treatment Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.