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General NPI Number Information
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NPI Number | 1013312107
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Entity Type | Organization
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Legal Business Name | HAVEN BEHAVIORAL SERVICES OF PUEBLO, LLC
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 1330 QUAIL LAKE LOOP SUITE 240
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4651
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Country | US
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Telephone | 719-640-5445
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Fax | 719-355-1789
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Provider Business Mailing Address
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Address Line | 3102 WEST END AVENUE SUITE 1000
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City | NASHVILLE
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State | TN
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Zip | 37203-1324
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Country | US
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Telephone | 615-393-8800
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Fax | 615-393-8844
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Authorized Official
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Title or Position | AVP REVENUE CYCLE
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Name | MS. CHRISTY KELTNER
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Credential |
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Telephone | 615-393-8816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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