Healthcare Provider Details

I. General information

NPI: 1457337750
Provider Name (Legal Business Name): HAVEN COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7726 US HWY 165
COLUMBIA LA
71418-7726
US

IV. Provider business mailing address

7726 US HWY 165
COLUMBIA LA
71418-7726
US

V. Phone/Fax

Practice location:
  • Phone: 318-649-9809
  • Fax: 318-649-9825
Mailing address:
  • Phone: 318-649-9809
  • Fax: 318-649-9825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number10608
License Number StateLA

VIII. Authorized Official

Name: MR. JENNIFER A DONALIES
Title or Position: BUSINESS OFFICE/AR
Credential:
Phone: 318-649-9809