Healthcare Provider Details

I. General information

NPI: 1407773997
Provider Name (Legal Business Name): TS & JR HAVEN BEHAVIORAL HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 PALOMAR AVE
DAYTON OH
45426-1943
US

IV. Provider business mailing address

8139 OLD TROY PIKE STE 1022
HUBER HEIGHTS OH
45424-1067
US

V. Phone/Fax

Practice location:
  • Phone: 937-270-5452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHIRLETA TIFFANY RUTLEDGE
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 937-270-5452