Provider Demographics
NPI:1851434740
Name:PRECIOUS HAVEN INC.
Entity Type:Organization
Organization Name:PRECIOUS HAVEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MCNEILL
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-868-6092
Mailing Address - Street 1:PO BOX 25821
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5013
Mailing Address - Country:US
Mailing Address - Phone:910-868-6092
Mailing Address - Fax:910-868-8882
Practice Address - Street 1:315 DICK ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5729
Practice Address - Country:US
Practice Address - Phone:910-868-6092
Practice Address - Fax:910-868-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X, 101YM0800X, 253J00000X
NCMHL-047-155251S00000X, 320800000X, 323P00000X
NCMHL-026-959251S00000X, 320800000X
NCMHL-026-673251S00000X, 322D00000X
NCMHL026-834251S00000X
NCMHL-026-924322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603455Medicaid
NC8301769GMedicaid
NCMHL-047-155Medicaid
NC6008367Medicaid
NC6604463Medicaid