Provider Demographics
NPI:1245121243
Name:KAVANA CARE UT LLC
Entity type:Organization
Organization Name:KAVANA CARE UT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-371-9500
Mailing Address - Street 1:2825 E COTTONWOOD PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7060
Mailing Address - Country:US
Mailing Address - Phone:732-339-7360
Mailing Address - Fax:
Practice Address - Street 1:2825 E COTTONWOOD PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-7055
Practice Address - Country:US
Practice Address - Phone:163-719-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty