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General NPI Number Information
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NPI Number | 1457337750
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Entity Type | Organization
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Legal Business Name | HAVEN COMMUNITY CARE
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7726 US HWY 165
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City | COLUMBIA
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State | LA
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Zip | 71418-7726
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Country | US
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Telephone | 318-649-9809
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Fax | 318-649-9825
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Provider Business Mailing Address
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Address Line | 7726 US HWY 165
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City | COLUMBIA
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State | LA
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Zip | 71418-7726
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Country | US
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Telephone | 318-649-9809
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Fax | 318-649-9825
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Authorized Official
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Title or Position | BUSINESS OFFICE/AR
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Name | MR. JENNIFER A DONALIES
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Credential |
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Telephone | 318-649-9809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 10608
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License Number State | LA
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