Provider Demographics
NPI:1215375472
Name:HOPE HAVEN
Entity Type:Organization
Organization Name:HOPE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEASER
Authorized Official - Suffix:
Authorized Official - Credentials:SAC
Authorized Official - Phone:608-577-3112
Mailing Address - Street 1:3602 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1106
Mailing Address - Country:US
Mailing Address - Phone:608-249-2600
Mailing Address - Fax:608-242-0021
Practice Address - Street 1:3602 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1106
Practice Address - Country:US
Practice Address - Phone:608-249-2600
Practice Address - Fax:608-242-0021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115813-131324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility