Provider Demographics
NPI:1780974949
Name:HAVEN YOUTH CENTER INC
Entity type:Organization
Organization Name:HAVEN YOUTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAWNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:267-776-4417
Mailing Address - Street 1:6934 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1823
Mailing Address - Country:US
Mailing Address - Phone:267-776-4417
Mailing Address - Fax:
Practice Address - Street 1:6934 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-1823
Practice Address - Country:US
Practice Address - Phone:267-776-4417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare