Haven House Community Support Center of Price County

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

753145419 Issued in WI

Legal business name

HAVEN HOUSE COMMUNITY SUPPORT CENTER OF PRICE COUNTY

Practice address

548 N Lake Ave
Phillips, WI 54555

Phone

(715) 339-6449

Fax

(715) 339-6450

NPI assigned

Apr 11, 2008

Last updated

Oct 20, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

HAVEN HOUSE COMMUNITY SUPPORT CENTER OF PRICE COUNTYAs reported in NPPES

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

Authorized official

Name

Ms. Pamela Marie Olson, LICENSED CLINICAL SONPI 1285892414

Title

Clinical Coordinator

Phone

(715) 339-6449

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Haven House Community Support Center of Price Co Former legal business name

Tax ID family

Haven House2 organizations share this tax ID, including this one

Part of

Rusk County CSP

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Haven House

  dba Safe Haven Counseling

  • Psychiatric/Mental Health Registered Nurse
  • Phillips, WI
  • NPI 1740564525
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pamela Marie Olson, LCSW

  • Clinical Social Worker
  • Phillips, WI
  • NPI 1285892414
  Authorized official Same address or phone

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1942473780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 N LAKE AVE",
            "city": "PHILLIPS",
            "state": "WI",
            "postal_code": "54555",
            "telephone_number": "715-339-6449",
            "fax_number": "715-339-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "548 N LAKE AVE",
            "city": "PHILLIPS",
            "state": "WI",
            "postal_code": "54555",
            "telephone_number": "715-339-6449",
            "fax_number": "715-339-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN HOUSE COMMUNITY SUPPORT CENTER OF PRICE COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAVEN HOUSE COMMUNITY SUPPORT CENTER OF PRICE COUNTY",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CLINICAL COORDINATOR",
        "authorized_official_telephone_number": "715-339-6449",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICENSED CLINICAL SO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "753145419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43429400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haven House Community Support Center of Price Co",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nicholas John Franssen, N.P.
• Dewane D. Frase, D.C.
• Timothy A Gehrke
• Haven House (Safe Haven Counseling)
• Haven House Community Support Center LLC (Safe Haven Counseling)
• Hearing Advantage LLC
• Carol Jane Heinlein, PC-IT, SAC-IT
• Melody Jean Jorgensen
• Deborah A Kozak, MD
• Nicole Kulwicki, NP-C

• Community/Behavioral Health Agency in Phillips, WI
• Providers in Phillips, WI by specialty
• Community/Behavioral Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; 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.