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General NPI Number Information
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NPI Number | 1104447770
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Entity Type | Organization
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Legal Business Name | HAVEN COMMUNITY AND SOCIAL SERVICES AGENCY
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 43284 W ARIZONA AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-8236
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Country | US
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Telephone | 520-350-4697
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Fax |
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Provider Business Mailing Address
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Address Line | 43284 W ARIZONA AVE
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City | MARICOPA
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State | AZ
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Zip | 85138-8236
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Country | US
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Telephone | 520-350-4697
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | TAMLA D ALEXANDER
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Credential |
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Telephone | 520-350-4697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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