Provider Demographics
NPI:1275974636
Name:HAVEN BEHAVIORAL SERVICES OF FT. WORTH, LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF FT. WORTH, LLC
Other - Org Name:HAVEN BEHAVIORAL HOSPITAL OF FT. WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-9064
Mailing Address - Street 1:652 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3191
Mailing Address - Country:US
Mailing Address - Phone:615-250-9500
Mailing Address - Fax:
Practice Address - Street 1:1000 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3366
Practice Address - Country:US
Practice Address - Phone:615-250-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital