Haven at Blue Creek LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

HAVEN AT BLUE CREEK LLC

Practice address

2582 Blue Creek LN
Grimesland, NC 27837-9641

Phone

(877) 342-8362

NPI assigned

Jul 11, 2022

Last updated

Jul 11, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Colleen Marie Balot

Title

Ceo

Phone

(877) 342-8362

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1447984075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 E ARLINGTON BLVD STE 113",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278587854",
            "telephone_number": "877-342-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2582 BLUE CREEK LN",
            "city": "GRIMESLAND",
            "state": "NC",
            "postal_code": "278379641",
            "telephone_number": "877-342-8362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN AT BLUE CREEK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "BALOT",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-342-8362",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie B Dudley
• Kimberly Dawn Ennis, LCSW
• Latonya Harris Grimes, MSW, LCSW
• Anthony Harris
• George Brian Harris, LCAS-A, LPCA
• Chris Carpenter Horn, MA, BCBA, LBA
• Shalana Keel, MSN, RN, APRN, PMHNP
• Jamie Lassiter, M.S.CCC-SLP
• Life Options
• Life Primary Care Clinic, PLLC

• Substance Abuse Rehabilitation Facility in Grimesland, NC
• Providers in Grimesland, NC by specialty
• Substance Abuse Rehabilitation Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.