Provider Demographics
NPI:1598850364
Name:HAVEN OF POSITIVE ENRICHMENT, INC.
Entity Type:Organization
Organization Name:HAVEN OF POSITIVE ENRICHMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GUILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:252-946-9427
Mailing Address - Street 1:858 HACKNEY AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4246
Mailing Address - Country:US
Mailing Address - Phone:252-946-9427
Mailing Address - Fax:252-946-9872
Practice Address - Street 1:858 HACKNEY AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4246
Practice Address - Country:US
Practice Address - Phone:252-946-9427
Practice Address - Fax:252-946-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017R5OtherBLUECROSSBLUESHIELD OF NC
NC8301067BMedicaid
NC8301067GMedicaid
NC8301067HMedicaid