Provider Demographics
NPI:1639686728
Name:THE HAVEN AT COLLEGE
Entity Type:Organization
Organization Name:THE HAVEN AT COLLEGE
Other - Org Name:THE HAVEN AT COLLEGE MARYLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-567-6645
Mailing Address - Street 1:7997 CAMINO PREDERA
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1919
Mailing Address - Country:US
Mailing Address - Phone:310-567-6645
Mailing Address - Fax:
Practice Address - Street 1:4321 HARTWICK RD STE 210
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3210
Practice Address - Country:US
Practice Address - Phone:310-567-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY GRADS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit