Provider Demographics
NPI:1932416377
Name:CHRIST'S HAVEN FOR CHILDREN
Entity Type:Organization
Organization Name:CHRIST'S HAVEN FOR CHILDREN
Other - Org Name:HAVEN'S HORSES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBARTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-431-1544
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-0467
Mailing Address - Country:US
Mailing Address - Phone:817-741-7614
Mailing Address - Fax:
Practice Address - Street 1:4200 KELLER HASLET ROAD
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-741-7614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty