Provider Demographics
NPI:1821690363
Name:HAVEN HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:HAVEN HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-450-5778
Mailing Address - Street 1:2301 NE 81ST ST APT E43
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-2023
Mailing Address - Country:US
Mailing Address - Phone:360-980-2166
Mailing Address - Fax:
Practice Address - Street 1:1404 NE 134TH ST STE 180C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2799
Practice Address - Country:US
Practice Address - Phone:360-450-5778
Practice Address - Fax:833-992-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health