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General NPI Number Information
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NPI Number | 1104371921
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Entity Type | Organization
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Legal Business Name | GIRLS' HAVEN
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 3380 FANNIN ST
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City | BEAUMONT
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State | TX
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Zip | 77701-3840
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Country | US
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Telephone | 409-832-6223
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Fax | 409-813-2766
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Provider Business Mailing Address
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Address Line | 3380 FANNIN ST
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City | BEAUMONT
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State | TX
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Zip | 77701-3840
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Country | US
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Telephone | 409-832-6223
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Fax | 409-813-2766
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. CHRISTINE MARIE MCNEELY
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Credential |
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Telephone | 409-832-6223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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