Provider Demographics
NPI:1194364380
Name:SWEET HAVEN HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:SWEET HAVEN HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:434-981-7866
Mailing Address - Street 1:2560 KIMBROUGH CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-9516
Mailing Address - Country:US
Mailing Address - Phone:434-981-7866
Mailing Address - Fax:804-282-9135
Practice Address - Street 1:2560 KIMBROUGH CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-9516
Practice Address - Country:US
Practice Address - Phone:434-981-7866
Practice Address - Fax:804-282-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty