Provider Demographics
NPI:1912213026
Name:NEW HAVEN FAMILY SERVICES INC.
Entity Type:Organization
Organization Name:NEW HAVEN FAMILY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:IDRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-501-7655
Mailing Address - Street 1:9320 LONG CREEK FAIRWAY DR
Mailing Address - Street 2:BOX 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2599
Mailing Address - Country:US
Mailing Address - Phone:704-501-7655
Mailing Address - Fax:704-665-5715
Practice Address - Street 1:9320 LONG CREEK FAIRWAY DR
Practice Address - Street 2:BOX 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2599
Practice Address - Country:US
Practice Address - Phone:704-501-7655
Practice Address - Fax:704-665-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health