Provider Demographics
NPI:1811701675
Name:HAVEN WELLNESS COMPANY
Entity type:Organization
Organization Name:HAVEN WELLNESS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOBLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-807-4122
Mailing Address - Street 1:22804 W BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22804 W BLUFF DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-8261
Practice Address - Country:US
Practice Address - Phone:503-807-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center