| Organization Name: | LAVERNE'S HAVEN RESIDENTIAL SERVICES |
| NPI Number: | 1760875728 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFERY LYNN WOMACK (OWNER/OPERATOR) |
| Mailing Address: | 195 Brookside Dr Eden |
| State: | NC US |
| Postal Code: | 272888123 |
| Phone Number: | 3366273262 |
| Fax Number: | |
| NPI Enumeration Date: | 03/13/2015 |
| NPI Last Update Date: | 03/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320600000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |