Healthcare Provider Details

I. General information

NPI: 1477037133
Provider Name (Legal Business Name): HILLTOP HAVEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 IL ROUTE 173
RICHMOND IL
60071-9628
US

IV. Provider business mailing address

PO BOX 35
LIBERTYVILLE IL
60048-0035
US

V. Phone/Fax

Practice location:
  • Phone: 877-570-7970
  • Fax: 855-570-3738
Mailing address:
  • Phone: 877-570-7970
  • Fax: 855-570-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CAREY JEANNE WOODRUFF
Title or Position: FOUNDER
Credential: PHD
Phone: 847-942-9084