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HAVEN DETOX MA OPERATING SUBSIDIARY, LLC
NPI 1235088667
Community Based Residential Treatment Facility, Mental Illness in Worcester, MA

Active since January 27, 2026CLIA 22D2225560 · Waiver
1369 GRAFTON ST, WORCESTER, MA 01604(508) 522-3180 Get Directions Write a Review

NPPES record last updated: May 28, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 28, 2026, Mar 25, 2026, Jan 27, 2026 (3 updates tracked since 2026).

About Haven Detox Ma Operating Subsidiary, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAVEN DETOX MA OPERATING SUBSIDIARY, LLC (NPI 1235088667) is a healthcare organization registered as a community based residential treatment facility, mental illness in Worcester, Massachusetts and active in the NPI registry since January 2026. The organization holds a CLIA Waiver certificate valid through May 20, 2027 and lists Tara Gurney, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1235088667
Entity TypeOrganization
Primary Taxonomy320800000X
Legal Business NameHAVEN DETOX MA OPERATING SUBSIDIARY, LLC
Location Address1369 GRAFTON STWorcester, MA 01604-2737
Mailing Address2925 10th Ave NPalm Springs, FL 33461-3000
Phone(508) 522-3180
Organization SubpartNo
Authorized OfficialTara GurneyAuthorized Official · (561) 517-3400
Enumeration DateJanuary 27, 2026
Last NPPES UpdateMay 28, 20263 updates tracked since enumeration
NPPES CertifiedMay 28, 2026
✔ NPI 1235088667 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X
Also ListedSubstance Abuse Rehabilitation FacilityTaxonomy 324500000X
1369 GRAFTON ST, Worcester, MA 01604
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 22D2225560

Haven Detox Ma Operating Subsidiary, LLC · Worcester, MA
Active · expires May 20, 2027
CLIA Number22D2225560
Laboratory TypeSubstance Abuse Facility
Certificate Effective DateMay 21, 2025
Certificate Expiration DateMay 20, 2027
Laboratory DirectorDr. Fariba Miryousefi
Laboratory Phone(561) 307-1212
Laboratory LocationHaven Detox Ma Operating Subsidiary, LLC1369 Grafton St, Worcester, MA 01604
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LETICIA ADRIANA FLORES
Social Worker (Clinical)
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (857) 341-4633
MR. CHRISTOPHER GIANFRIDDO OTR/L
Occupational Therapist
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (508) 373-7400
JANET PELLETTI
Physical Therapist (Geriatrics)
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (508) 373-7400
DR. PETRA KAJLA M.D.
Internal Medicine
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (508) 373-7400
HAVEN NEW ENGLAND: MH
Community Based Residential Treatment Facility, Mental Illness
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (561) 635-2400
NICOLE DESABRAIS LICSW
Social Worker (Clinical)
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (508) 373-7400
PATRICIA ANN LAZAREK LICSW
Social Worker (Clinical)
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (508) 373-7414
MARIE JOHANNE JOSEPH
Nurse Practitioner (Psychiatric/Mental Health)
1369 GRAFTON ST
WORCESTER, MA 01604
Worcester County (855) 614-0111

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Haven Detox Ma Operating Subsidiary, LLC's NPI number?

The NPI number for Haven Detox Ma Operating Subsidiary, LLC is 1235088667. It was assigned to this organization in the NPPES registry on January 27, 2026.

Where is Haven Detox Ma Operating Subsidiary, LLC located?

Haven Detox Ma Operating Subsidiary, LLC is located at 1369 Grafton St, Worcester, MA 01604. The listed phone number is (508) 522-3180.

What is Haven Detox Ma Operating Subsidiary, LLC's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.

Does Haven Detox Ma Operating Subsidiary, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 22D2225560) is associated with this NPI, valid through May 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Haven Detox Ma Operating Subsidiary, LLC was last updated on May 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.