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General NPI Number Information
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NPI Number | 1265416994
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Entity Type | Organization
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Legal Business Name | HAVEN HOUSE, INC .
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1195 AUGUSTINE HERMAN HWY
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City | ELKTON
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State | MD
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Zip | 21921-8252
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Country | US
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Telephone | 410-398-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 AUGUSTINE HERMAN HWY PO BOX 723
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City | ELKTON
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State | MD
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Zip | 21921-8252
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Country | US
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Telephone | 410-398-9900
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JESSIE COSTLEY
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Credential |
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Telephone | 443-839-6928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 8314
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License Number State | MD
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