Basic Information
| Provider Information | |||||||||
| NPI: | 1164067765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAVEN BEHAVIORAL OUTPATIENT SERVICES OF COLORADO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 QUAIL LAKE LOOP STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809064651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195402152 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6160 TUTT BLVD STE 120 | ||||||||
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| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809233503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196447511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | TERRANOVA | ||||||||
| AuthorizedOfficialFirstName: | SHERIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7195402152 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.