Provider Demographics
NPI:1164779716
Name:WING HAVEN
Entity Type:Organization
Organization Name:WING HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:740-645-8536
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-0171
Mailing Address - Country:US
Mailing Address - Phone:740-388-8567
Mailing Address - Fax:740-388-8566
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686
Practice Address - Country:US
Practice Address - Phone:740-388-8567
Practice Address - Fax:740-388-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health