Provider Demographics
NPI:1346574134
Name:BETHEL HAVEN, INC
Entity Type:Organization
Organization Name:BETHEL HAVEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-310-9046
Mailing Address - Street 1:1030 VILLAGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6004
Mailing Address - Country:US
Mailing Address - Phone:706-310-9046
Mailing Address - Fax:706-310-9076
Practice Address - Street 1:1030 VILLAGE DR STE B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6004
Practice Address - Country:US
Practice Address - Phone:706-310-9046
Practice Address - Fax:706-310-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty