Provider Demographics
NPI:1245815323
Name:THE HAVEN OF TAMPA BAY CORP.
Entity type:Organization
Organization Name:THE HAVEN OF TAMPA BAY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-610-5449
Mailing Address - Street 1:5110 N ARMENIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1406
Mailing Address - Country:US
Mailing Address - Phone:813-348-0944
Mailing Address - Fax:813-348-0944
Practice Address - Street 1:5110 N ARMENIA AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1406
Practice Address - Country:US
Practice Address - Phone:813-348-4814
Practice Address - Fax:813-348-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health