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Organization
BLUE HAVEN GROUP CORP
Active
Organization
BLUE HAVEN GROUP CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS J. ARIZA (PRESIDENT)
(954) 540-6470
Entity
Organization
Contact information
Practice address
3241 NW 108TH DR, CORAL SPRINGS, FL 33065-3528
(954) 540-6470
(954) 796-7104
Mailing address
3241 NW 108 DR., CORAL SPRINGS, FL 33065
(654) 588-1916
(954) 796-7104
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
10-2794GH
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
10-2899GH
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
10-2941GH
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
682933396
—
FL
Enumeration date
02/06/2017
Last updated
02/06/2017
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