Provider Demographics
NPI:1679538433
Name:PEACE HAVEN ASSOCIATION
Entity Type:Organization
Organization Name:PEACE HAVEN ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-965-3833
Mailing Address - Street 1:12630 ROTT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1214
Mailing Address - Country:US
Mailing Address - Phone:314-965-3833
Mailing Address - Fax:314-965-5260
Practice Address - Street 1:12630 ROTT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1214
Practice Address - Country:US
Practice Address - Phone:314-965-3833
Practice Address - Fax:314-965-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030123282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261993Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER