| Organization Name: | HAVEN HEALTH CARE MEDICAL CLINIC, INC |
| NPI Number: | 1336278365 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NOVA C CRAWFORD (PRESIDENT) |
| Mailing Address: | 502 W Sturdivant St Advance |
| State: | MO US |
| Postal Code: | 637307261 |
| Phone Number: | 5737229191 |
| Fax Number: | 5737229393 |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 08/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 268934 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |