Provider Demographics
| NPI: | 1639741440 |
|---|---|
| Name: | HAVEN FOR SUCCESS LLC |
| Entity Type: | Organization |
| Organization Name: | HAVEN FOR SUCCESS LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | EBONY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PEAVY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 346-291-0675 |
| Mailing Address - Street 1: | PO BOX 30313 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HOUSTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77249-0313 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 832-217-9306 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 9258 SOLVISTA PASS LN |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77070-2146 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 346-291-0675 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-07-12 |
| Last Update Date: | 2021-08-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251B00000X | Agencies | Case Management | ||
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 172A00000X | Other Service Providers | Driver | Group - Multi-Specialty | |
| No | 174200000X | Other Service Providers | Meals | ||
| No | 177F00000X | Other Service Providers | Lodging | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 253J00000X | Agencies | Foster Care Agency | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | ||
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
