Provider Demographics
NPI:1336330935
Name:NEW HAVEN CHILDREN SERVICES
Entity Type:Organization
Organization Name:NEW HAVEN CHILDREN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:804-644-2245
Mailing Address - Street 1:905 MAPLEGROVE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2637
Mailing Address - Country:US
Mailing Address - Phone:804-644-2245
Mailing Address - Fax:
Practice Address - Street 1:905 MAPLEGROVE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2637
Practice Address - Country:US
Practice Address - Phone:804-644-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS35507320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness