Provider Demographics
NPI:1427388578
Name:NEWHAVEN
Entity Type:Organization
Organization Name:NEWHAVEN
Other - Org Name:CROSBY & SHAW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-896-7669
Mailing Address - Street 1:615 SOUTH HUTCHINSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620
Mailing Address - Country:US
Mailing Address - Phone:229-896-7669
Mailing Address - Fax:229-896-9703
Practice Address - Street 1:615 SOUTH HUTCHINSON AVENUE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620
Practice Address - Country:US
Practice Address - Phone:229-896-7669
Practice Address - Fax:229-896-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03701005320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities