# HAVEN RECOVERY AZ LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396115234
- **Authorized official:** ERICH BRUESCHKE (MEMBER)
- **Authorized official phone:** (405) 834-2993

## Contact information

- **Practice address:** 9524 W CAMELBACK RD, STE C-130, \#293, GLENDALE, AZ 85305-3104
- **Practice address phone:** (405) 834-2993
- **Mailing address:** 9524 W CAMELBACK RD, STE C-130, \#293, GLENDALE, AZ 85305-3104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/05/2015
- **Last updated:** 10/05/2015