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General NPI Number Information
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NPI Number | 1306147277
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Entity Type | Organization
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Legal Business Name | FAIR HAVEN CHILDREN'S HOME
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 3132 N FAIR HAVEN LOOP
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City | STRAFFORD
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State | MO
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Zip | 65757-8619
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Country | US
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Telephone | 417-882-4485
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Fax |
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Provider Business Mailing Address
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Address Line | 3132 N FAIR HAVEN LOOP
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City | STRAFFORD
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State | MO
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Zip | 65757-8619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BARNEY CRAWFORD
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Credential |
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Telephone | 417-862-6675
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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 | MO
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