=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649754540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVEN BEHAVIORAL SERVICES OF READING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2018
-----------------------------------------------------
Last Update Date | 09/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 N 6TH ST
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19601-3096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-406-4345
-----------------------------------------------------
Fax | 610-898-8003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3102 W END AVE STE 1000
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-393-8816
-----------------------------------------------------
Fax | 615-393-8844
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPTROLLER
-----------------------------------------------------
Name | JANIE PICKLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-393-8809
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------