Provider Demographics
NPI:1366850760
Name:HAVEN WARRIOR SUPPORT CENTER
Entity Type:Organization
Organization Name:HAVEN WARRIOR SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-640-5445
Mailing Address - Street 1:1330 QUAIL LAKE LOOP STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-640-5445
Mailing Address - Fax:719-355-1789
Practice Address - Street 1:1330 QUAIL LAKE LOOP STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-640-5445
Practice Address - Fax:719-355-1789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN BEHAVIORAL HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64231251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health