Provider Demographics
NPI:1790979284
Name:TRI VALLEY HAVEN FOR WOMEN
Entity Type:Organization
Organization Name:TRI VALLEY HAVEN FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:925-449-5845
Mailing Address - Street 1:3663 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-7062
Mailing Address - Country:US
Mailing Address - Phone:925-449-5845
Mailing Address - Fax:925-449-2684
Practice Address - Street 1:3663 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-7062
Practice Address - Country:US
Practice Address - Phone:925-449-5845
Practice Address - Fax:925-449-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health