Provider Demographics
NPI:1629529524
Name:HAVEN BEHAVIORAL SERVICES OF FRISCO LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF FRISCO LLC
Other - Org Name:HAVEN BEHAVIORAL HOSPITAL OF FRISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-393-8816
Mailing Address - Street 1:3102 W END AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1301
Mailing Address - Country:US
Mailing Address - Phone:615-393-8800
Mailing Address - Fax:615-393-8844
Practice Address - Street 1:5680 FRISCO SQUARE BLVD
Practice Address - Street 2:SUITE 3000
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3300
Practice Address - Country:US
Practice Address - Phone:469-535-8000
Practice Address - Fax:469-535-8802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN BEHAVIORAL HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX466793Medicare PIN