MEDICARE: HAVEN MINISTIRES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	200301378	NC

General Provider Information

NPI Number	:	1528371614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN MINISTIRES, INC.

Provider Business Mailing Address
First Line	:	7212 OYSTER LN
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-7132
Country	:	US
Telephone Number	:	910-803-1620
Fax Number	:	215-902-4882

Provider Business Practice Location Address
First Line	:	107 CHURCH ST
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-1909
Country	:	US
Telephone Number	:	910-803-1620
Fax Number	:	215-902-4882

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. DWIGHT HOWARD LYSNE
Credential	:	MD, MDIV
Telephone Number	:	910-803-1620

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

Similar Medicare Providers

1366517872 — MS. TERESA B HOPKINS FNP
Practice Location Address:

107 CHURCH ST
LAKE WACCAMAW, NC
28450-1909

Practice Phone: 910-646-2107
Practice Fax: 910-646-2252

1992019335 — HAVEN MINISTRIES, INC.
Practice Location Address:

107 CHURCH ST
LAKE WACCAMAW, NC
28450-1909

Practice Phone: 910-803-1620
Practice Fax: 215-902-4882

1750246591 — PREMIER LIVING AND HEALTHCARE CENTER LLC
Practice Location Address:

106 CAMERON ST
LAKE WACCAMAW, NC
28450-1900

Practice Phone: 910-646-3132
Practice Fax:

1720085293 — PREMIER LIVING AND REHAB CENTER
Practice Location Address:

106 CAMERON ST
LAKE WACCAMAW, NC
28450-1900

Practice Phone: 910-646-3132
Practice Fax: 910-646-4071

1669555603 — EGB ENTERPRISES INC
Practice Location Address:

108 OLD E HWY 74/76
LAKE WACCAMAW, NC
28450-0148

Practice Phone: 910-646-3400
Practice Fax: 910-646-4056

1366593170 — MR. EUGENE GLENN BROWN JR. RPH
Practice Location Address:

108 E. HIGHWAY 74-76
LAKE WACCAMAW, NC
28450

Practice Phone: 910-646-3400
Practice Fax: 910-646-4056

Directions to “HAVEN MINISTIRES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.