Provider Demographics
NPI:1750839015
Name:CHILD HAVE,N INC
Entity Type:Organization
Organization Name:CHILD HAVE,N INC
Other - Org Name:CHILD HAVEN - VALLEJO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-425-5744
Mailing Address - Street 1:801 EMPIRE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5702
Mailing Address - Country:US
Mailing Address - Phone:707-425-5744
Mailing Address - Fax:707-425-5162
Practice Address - Street 1:236 GEORGIA ST
Practice Address - Street 2:STE 202
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5991
Practice Address - Country:US
Practice Address - Phone:707-425-5744
Practice Address - Fax:707-425-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32744251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health