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General NPI Number Information
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NPI Number | 1780974949
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Entity Type | Organization
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Legal Business Name | HAVEN YOUTH CENTER INC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 6934 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-1823
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Country | US
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Telephone | 267-776-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 6934 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-1823
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Country | US
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Telephone | 267-776-4417
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM BRAWNER
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Credential | MA
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Telephone | 267-776-4417
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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 |
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License Number State |
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