Provider Demographics
NPI:1306008883
Name:HAVEN CORP.
Entity Type:Organization
Organization Name:HAVEN CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:719-590-4124
Mailing Address - Street 1:1155 KELLY JOHNSON BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3957
Mailing Address - Country:US
Mailing Address - Phone:719-590-4124
Mailing Address - Fax:
Practice Address - Street 1:125 N PARKSIDE DR STE 108
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6026
Practice Address - Country:US
Practice Address - Phone:719-448-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2007153889251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health