Provider Demographics
NPI:1659095289
Name:CHILDREN'S HAVEN OF SOUTHWEST MISSOURI, INC.
Entity Type:Organization
Organization Name:CHILDREN'S HAVEN OF SOUTHWEST MISSOURI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-782-4452
Mailing Address - Street 1:711 S PICHER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-3930
Mailing Address - Country:US
Mailing Address - Phone:417-782-4453
Mailing Address - Fax:417-782-1690
Practice Address - Street 1:711 S PICHER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3930
Practice Address - Country:US
Practice Address - Phone:417-782-4453
Practice Address - Fax:417-782-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency