Provider Demographics
NPI:1134308562
Name:DEHAVEN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:DEHAVEN HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, DAPA
Authorized Official - Phone:888-782-1138
Mailing Address - Street 1:131 RAY RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-5119
Mailing Address - Country:US
Mailing Address - Phone:888-782-1138
Mailing Address - Fax:912-525-3183
Practice Address - Street 1:121 RAY RD
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-5119
Practice Address - Country:US
Practice Address - Phone:888-782-1138
Practice Address - Fax:912-525-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health