Provider Demographics
NPI:1528382512
Name:HAVEN CORPORATION
Entity Type:Organization
Organization Name:HAVEN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:710-590-4124
Mailing Address - Street 1:1155 KELLY JOHNSON BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3932
Mailing Address - Country:US
Mailing Address - Phone:719-590-4124
Mailing Address - Fax:719-448-0870
Practice Address - Street 1:1155 KELLY JOHNSON BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3932
Practice Address - Country:US
Practice Address - Phone:719-590-4124
Practice Address - Fax:719-448-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5586251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health