Provider Demographics
NPI:1922520048
Name:HAVEN IN THE CITY
Entity Type:Organization
Organization Name:HAVEN IN THE CITY
Other - Org Name:HAVEN ACUPUNCTURE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERBY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-578-7977
Mailing Address - Street 1:666 LINCOLN AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3546
Mailing Address - Country:US
Mailing Address - Phone:612-258-4509
Mailing Address - Fax:
Practice Address - Street 1:666 LINCOLN AVE APT C
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3546
Practice Address - Country:US
Practice Address - Phone:612-258-4509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1774171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1295108819Medicaid