Provider Demographics
NPI:1518217439
Name:CHILD HAVEN
Entity Type:Organization
Organization Name:CHILD HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICUM TRAINEE
Authorized Official - Prefix:MR
Authorized Official - First Name:NAPOLEON
Authorized Official - Middle Name:
Authorized Official - Last Name:DARGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-325-3729
Mailing Address - Street 1:2301 MEGAN DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 MEGAN DR.
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:925-325-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No251B00000XAgenciesCase Management