Healthcare Provider Details

I. General information

NPI: 1023160876
Provider Name (Legal Business Name): HAVEN GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N OHENRY BLVD
GREENSBORO NC
27405-3807
US

IV. Provider business mailing address

3207 N OHENRY BLVD
GREENSBORO NC
27405-3807
US

V. Phone/Fax

Practice location:
  • Phone: 336-375-1078
  • Fax: 336-375-0046
Mailing address:
  • Phone: 336-375-1078
  • Fax: 336-375-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-041790
License Number StateNC

VIII. Authorized Official

Name: MISS YVONNE PINDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-375-1078