Provider Demographics
NPI:1831706761
Name:THE HAVEN PLACE LLC
Entity type:Organization
Organization Name:THE HAVEN PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-684-3059
Mailing Address - Street 1:7552 NAVARRE PKWY UNIT 24
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7308
Mailing Address - Country:US
Mailing Address - Phone:850-684-3059
Mailing Address - Fax:850-684-3060
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 24
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7308
Practice Address - Country:US
Practice Address - Phone:850-684-3059
Practice Address - Fax:850-684-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health