Provider Demographics
NPI:1710510045
Name:HAVENER VENTURES LLC
Entity Type:Organization
Organization Name:HAVENER VENTURES LLC
Other - Org Name:STAR LACTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVENER
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC RLC
Authorized Official - Phone:540-926-4111
Mailing Address - Street 1:7922 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-1847
Mailing Address - Country:US
Mailing Address - Phone:540-926-4111
Mailing Address - Fax:
Practice Address - Street 1:2311 SANFORD AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1122
Practice Address - Country:US
Practice Address - Phone:540-253-1984
Practice Address - Fax:540-566-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty