Provider Demographics
NPI:1881931095
Name:LANDMARK HAVEN, INC.
Entity type:Organization
Organization Name:LANDMARK HAVEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-534-4471
Mailing Address - Street 1:1233 HICKORY CREEK
Mailing Address - Street 2:
Mailing Address - City:GLADYS
Mailing Address - State:VA
Mailing Address - Zip Code:24554
Mailing Address - Country:US
Mailing Address - Phone:434-534-4471
Mailing Address - Fax:
Practice Address - Street 1:1233 HICKORY CREEK RD
Practice Address - Street 2:
Practice Address - City:GLADYS
Practice Address - State:VA
Practice Address - Zip Code:24554-2346
Practice Address - Country:US
Practice Address - Phone:434-534-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities