MEDICARE: HAVEN'S HOLISTIC HEALING LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1902619604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN'S HOLISTIC HEALING LLC

Provider Business Mailing Address
First Line	:	1035 SANDERS ST APT 148
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1888
Country	:	US
Telephone Number	:	812-322-4979
Fax Number	:

Provider Business Practice Location Address
First Line	:	6280 N COLLEGE AVE STE 150
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2199
Country	:	US
Telephone Number	:	812-322-4979
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHASTIDY HAVEN
Credential	:	FNP
Telephone Number	:	812-322-4979

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/07/2026

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