Provider Demographics
NPI:1801221064
Name:PEACEFUL HAVEN INC
Entity Type:Organization
Organization Name:PEACEFUL HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATONJA
Authorized Official - Middle Name:DESHAWN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-841-8725
Mailing Address - Street 1:221 56TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6761
Mailing Address - Country:US
Mailing Address - Phone:202-841-8725
Mailing Address - Fax:202-380-9054
Practice Address - Street 1:221 56TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6761
Practice Address - Country:US
Practice Address - Phone:202-841-8725
Practice Address - Fax:202-380-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies