Provider Demographics
NPI:1871839688
Name:CLINTON HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:CLINTON HOSPITAL CORPORATION
Other - Org Name:HAVEN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3672
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7488
Mailing Address - Fax:615-469-6505
Practice Address - Street 1:208 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2025
Practice Address - Country:US
Practice Address - Phone:570-748-0590
Practice Address - Fax:570-748-0596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINTON HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-26
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA122201261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007550910020Medicaid
PA393423Medicare Oscar/Certification