Provider Demographics
NPI:1760670574
Name:HAVEN GROUP HOMES
Entity Type:Organization
Organization Name:HAVEN GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-375-1078
Mailing Address - Street 1:PO BOX 14596
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4596
Mailing Address - Country:US
Mailing Address - Phone:336-375-1078
Mailing Address - Fax:336-375-0046
Practice Address - Street 1:3207 O' HENRY BLVD N
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3807
Practice Address - Country:US
Practice Address - Phone:336-375-1078
Practice Address - Fax:336-375-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL0417903104A0625X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805851Medicaid