Haven House Community Support Center LLC
Organization Active NPI Community/Behavioral Health Agency · Phillips, WI
NPI 1043473606 · NPPES record last updated Feb 14, 2012
Key facts
- NPI
- 1043473606
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 2793 (WI)
- Legal business name
- HAVEN HOUSE COMMUNITY SUPPORT CENTER LLC
- Practice address
- 548 N Lake Ave
Phillips, WI 54555-1028 - Phone
- (715) 339-6453
- Fax
- (715) 339-6450
- NPI assigned
- Jul 3, 2008
- Organization subpart
- No
Authorized official
- Name
- Mrs. Pamela Olson
- Title
- Owner
- Phone
- (715) 339-6453
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 2793 | WI | Yes |
Addresses
Primary practice location
548 N Lake Ave
Phillips, WI 54555-1028
Mailing address
548 N Lake Ave
Phillips, WI 54555-1028
Phone (715) 339-6453
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42255200 | Medicaid | WI |
Other names
- Safe Haven Counseling
Other providers in Phillips, WI
- Flambeau Hospital Inc
- Nicholas John Franssen
- Dewane D. Frase
- Timothy A Gehrke
- Haven House
- Haven House Community Support Center of Price County
- Hearing Advantage LLC
- Carol Jane Heinlein
- Melody Jean Jorgensen
- Deborah A Kozak
All providers in Phillips, WI · Community/Behavioral Health Agency in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.