Provider Demographics
NPI:1578668513
Name:CHILDHAVEN, INC.
Entity Type:Organization
Organization Name:CHILDHAVEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:256-734-6720
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:1816 CHILDHAVEN RD
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-2070
Mailing Address - Country:US
Mailing Address - Phone:256-734-6720
Mailing Address - Fax:256-734-6721
Practice Address - Street 1:1816 CHILDHAVEN RD NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5902
Practice Address - Country:US
Practice Address - Phone:256-734-6720
Practice Address - Fax:256-734-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000295322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children