Organization
HAPPY HAVEN AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAEL KAROMBA (CEO)
(857) 200-7660
Entity
Organization
Contact information
Practice address
1110 W HADLEY ST, PHOENIX, AZ 85007-3610
(857) 200-7660
(602) 675-1847
Mailing address
1110 W HADLEY ST, PHOENIX, AZ 85007-3610
(857) 200-7660
(602) 675-1847
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH6042
—
AZ
Enumeration date
03/16/2020
Last updated
03/16/2020
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