Organization Name: | HAVEN HOUSE |
NPI Number: | 1740564525 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAMELA OLSON (CLINICAL COORDINATOR) |
Mailing Address: | 548 N Lake Ave Phillips |
State: | WI US |
Postal Code: | 545551028 |
Phone Number: | 7153396453 |
Fax Number: | |
NPI Enumeration Date: | 09/28/2011 |
NPI Last Update Date: | 09/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0808X |
License Number: | 57598-30 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |