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General NPI Number Information
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NPI Number | 1023160876
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Entity Type | Organization
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Legal Business Name | HAVEN GROUP HOMES
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 3209 N OHENRY BLVD
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City | GREENSBORO
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State | NC
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Zip | 27405-3807
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Country | US
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Telephone | 336-375-1078
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Fax | 336-375-0046
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Provider Business Mailing Address
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Address Line | 3207 N OHENRY BLVD
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City | GREENSBORO
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State | NC
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Zip | 27405-3807
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Country | US
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Telephone | 336-375-1078
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Fax | 336-375-0046
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS YVONNE PINDER
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Credential |
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Telephone | 336-375-1078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | MHL-041790
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License Number State | NC
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