Provider Demographics
NPI:1295327104
Name:HAVEN COMMUNITY HEALTH
Entity type:Organization
Organization Name:HAVEN COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-761-0886
Mailing Address - Street 1:7397 PRAIRIE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4457
Mailing Address - Country:US
Mailing Address - Phone:706-761-0886
Mailing Address - Fax:
Practice Address - Street 1:7397 PRAIRIE VALLEY CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4457
Practice Address - Country:US
Practice Address - Phone:706-761-0886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health