Provider Demographics
NPI:1841610441
Name:CREST HAVENE COMMUNITY CARE
Entity Type:Organization
Organization Name:CREST HAVENE COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:ARW
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-583-6471
Mailing Address - Street 1:5330 MOFFETT RD
Mailing Address - Street 2:5320 MOFFETT ROAD
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2904
Mailing Address - Country:US
Mailing Address - Phone:251-583-6471
Mailing Address - Fax:251-348-7165
Practice Address - Street 1:5330 MOFFETT RD
Practice Address - Street 2:5320 MOFFETT ROAD
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2904
Practice Address - Country:US
Practice Address - Phone:251-583-6471
Practice Address - Fax:251-348-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities