Provider Demographics
NPI:1609020361
Name:HAVEN HOME
Entity Type:Organization
Organization Name:HAVEN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-797-4720
Mailing Address - Street 1:765 E ROUTE 70
Mailing Address - Street 2:BUILDING A, SUITE 101
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-983-3900
Mailing Address - Fax:
Practice Address - Street 1:601 HAMILTON AVE FL 7
Practice Address - Street 2:ST. FRANCIS MEDICAL CENTER
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:856-983-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CFG RESIDENTIALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-07
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0147435Medicaid