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General NPI Number Information
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NPI Number | 1407773997
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Entity Type | Organization
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Legal Business Name | TS & JR HAVEN BEHAVIORAL HEALTH AGENCY
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Dates
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Enumeration Date | 07/04/2026
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Last Update Date | 07/04/2026
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Provider Practice Location Address
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Address Line | 4626 PALOMAR AVE
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City | DAYTON
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State | OH
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Zip | 45426-1943
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Country | US
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Telephone | 937-270-5452
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Fax |
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Provider Business Mailing Address
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Address Line | 8139 OLD TROY PIKE STE 1022
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-1067
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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 | EXECUTIVE ADMINISTRATOR
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Name | MRS. SHIRLETA TIFFANY RUTLEDGE
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Credential |
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Telephone | 937-270-5452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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