Healthcare Provider Details

I. General information

NPI: 1306147277
Provider Name (Legal Business Name): FAIR HAVEN CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 N FAIR HAVEN LOOP
STRAFFORD MO
65757-8619
US

IV. Provider business mailing address

3132 N FAIR HAVEN LOOP
STRAFFORD MO
65757-8619
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-4485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. BARNEY CRAWFORD
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-862-6675