Provider Demographics
NPI:1912341629
Name:HAVEN BEHAVIORAL SERVICES OF PHILADELPHIA, LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF PHILADELPHIA, LLC
Other - Org Name:HAVEN BEHAVIORAL HOSPITAL OF PHILADELPHIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-393-8809
Mailing Address - Street 1:3102 W END AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1324
Mailing Address - Country:US
Mailing Address - Phone:615-393-8800
Mailing Address - Fax:615-982-8123
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:615-250-9500
Practice Address - Fax:615-250-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029437890001Medicaid