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General NPI Number Information
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NPI Number | 1114684008
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Entity Type | Organization
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Legal Business Name | WOMANHAVEN
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 104 N 5TH ST
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City | EL CENTRO
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State | CA
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Zip | 92243-2404
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Country | US
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Telephone | 760-337-3915
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2219
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City | EL CENTRO
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State | CA
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Zip | 92244-2219
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Country | US
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Telephone | 760-337-3915
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GINA VARGAS
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Credential |
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Telephone | 760-353-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 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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