Provider Demographics
NPI:1295583730
Name:HEAVEN'S HAVEN
Entity type:Organization
Organization Name:HEAVEN'S HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSHEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:724-235-8855
Mailing Address - Street 1:6349 TUSCARAWAS RD
Mailing Address - Street 2:
Mailing Address - City:INDUSTRY
Mailing Address - State:PA
Mailing Address - Zip Code:15052-1953
Mailing Address - Country:US
Mailing Address - Phone:724-235-8855
Mailing Address - Fax:
Practice Address - Street 1:6349 TUSCARAWAS RD
Practice Address - Street 2:
Practice Address - City:INDUSTRY
Practice Address - State:PA
Practice Address - Zip Code:15052-1953
Practice Address - Country:US
Practice Address - Phone:724-235-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty