Provider Demographics
NPI:1518275759
Name:HAVEN BEHAVIORAL SERVICES OR READING, LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OR READING, LLC
Other - Org Name:HAVEN BEHAVIORAL HOSPITAL OF EASTERN PENNSYLVANIA OUTPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CORP COMPLIANCE&GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-9160
Mailing Address - Street 1:652 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3191
Mailing Address - Country:US
Mailing Address - Phone:615-250-9500
Mailing Address - Fax:615-250-9516
Practice Address - Street 1:640 WALNUT ST
Practice Address - Street 2:SUITE 303
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3504
Practice Address - Country:US
Practice Address - Phone:610-208-8860
Practice Address - Fax:610-208-8861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN BEHAVIORAL HEALTHCARE, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA222170261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health