Provider Demographics
NPI:1407193774
Name:HAVEN COMMUNITY HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:HAVEN COMMUNITY HEALTH SERVICES, LLC
Other - Org Name:HCHS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-244-7952
Mailing Address - Street 1:11 CARLEY LN
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8304
Mailing Address - Country:US
Mailing Address - Phone:570-244-7952
Mailing Address - Fax:
Practice Address - Street 1:11 CARLEY LN
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-8304
Practice Address - Country:US
Practice Address - Phone:570-244-7952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23723601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care