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General NPI Number Information
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NPI Number | 1568997849
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Entity Type | Organization
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Legal Business Name | W.O.R.C. HAVEN INC.
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 1090 JIMMY ANN DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4591
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Country | US
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Telephone | 386-274-4228
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Fax | 386-256-4874
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Provider Business Mailing Address
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Address Line | 9040 SUNSET DR
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City | MIAMI
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State | FL
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Zip | 33173-3432
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Country | US
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Telephone | 305-596-9040
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Fax | 305-275-3345
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Authorized Official
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Title or Position | SECRETARY/TREASURER/CFO
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Name | KAREN DAVIDSON
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Credential | MACC
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Telephone | 305-273-3023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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