Healthcare Provider Details

I. General information

NPI: 1578189742
Provider Name (Legal Business Name): ENGLISH HAVEN SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12578 FEE FEE RD
SAINT LOUIS MO
63146-3863
US

IV. Provider business mailing address

177 WELDON PKWY UNIT 1533
MARYLAND HEIGHTS MO
63043-5061
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-4048
  • Fax:
Mailing address:
  • Phone: 314-226-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHEAL TREMAYNE ENGLISH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-226-4048