MEDICARE: HAVEN YOUTH CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1780974949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN YOUTH CENTER INC

Provider Business Mailing Address
First Line	:	6934 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1823
Country	:	US
Telephone Number	:	267-776-4417
Fax Number	:

Provider Business Practice Location Address
First Line	:	6934 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1823
Country	:	US
Telephone Number	:	267-776-4417
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WILLIAM BRAWNER
Credential	:	MA
Telephone Number	:	267-776-4417

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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