Provider Demographics
NPI:1477198067
Name:HAVEN BEHAVIORAL OUTPATIENT SERVICES OF COLORADO, LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL OUTPATIENT SERVICES OF COLORADO, LLC
Other - Org Name:FAMILY SUPPORT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-540-2152
Mailing Address - Street 1:1330 QUAIL LAKE LOOP STE 200
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:719-540-2152
Mailing Address - Fax:
Practice Address - Street 1:155 PRINTERS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-6101
Practice Address - Country:US
Practice Address - Phone:719-540-2160
Practice Address - Fax:719-540-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)