Provider Demographics
NPI:1225585136
Name:KIRSTIN'S HAVEN, INC
Entity Type:Organization
Organization Name:KIRSTIN'S HAVEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-392-2876
Mailing Address - Street 1:5801 ALLENTOWN RD
Mailing Address - Street 2:310
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4563
Mailing Address - Country:US
Mailing Address - Phone:240-392-2876
Mailing Address - Fax:240-838-3015
Practice Address - Street 1:5801 ALLENTOWN RD
Practice Address - Street 2:310
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4563
Practice Address - Country:US
Practice Address - Phone:240-392-2876
Practice Address - Fax:240-838-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management