Organization
SWEET HAVEN LLC
Active
Organization
SWEET HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANI SHIQOW (CEO)
(480) 200-9183
Entity
Organization
Contact information
Practice address
1525 W PEPPER PL, MESA, AZ 85201-7011
(480) 200-9183
Mailing address
3001 W RAY RD SUITE 201, CHANDLER, AZ 85226
(480) 200-9183
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q14206
DEPARTMENT OF DEVELOPMENTAL DISABILITY
AZ
Enumeration date
11/23/2020
Last updated
11/23/2020
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