Provider Demographics
NPI:1720354012
Name:HAVEN CARE, LLC
Entity Type:Organization
Organization Name:HAVEN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-841-8099
Mailing Address - Street 1:11670 KADES TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-4012
Mailing Address - Country:US
Mailing Address - Phone:404-841-8099
Mailing Address - Fax:404-284-8395
Practice Address - Street 1:11670 KADES TRL
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-4012
Practice Address - Country:US
Practice Address - Phone:404-841-8099
Practice Address - Fax:404-284-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH006808320600000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities