Provider Demographics
NPI:1013312107
Name:HAVEN BEHAVIORAL SERVICES OF PUEBLO, LLC
Entity type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF PUEBLO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-393-8816
Mailing Address - Street 1:3102 WEST END AVENUE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1324
Mailing Address - Country:US
Mailing Address - Phone:615-393-8800
Mailing Address - Fax:615-393-8844
Practice Address - Street 1:1330 QUAIL LAKE LOOP
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-640-5445
Practice Address - Fax:719-355-1789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN BEHAVIORAL HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health