1780025148 NPI number — HAVEN BEHAVIORAL SERVICES OF FRISCO, LLC

Table of content: (NPI 1780025148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780025148 NPI number — HAVEN BEHAVIORAL SERVICES OF FRISCO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN BEHAVIORAL SERVICES OF FRISCO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAVEN BEHAVIORAL HOSPITAL OF FRISCO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780025148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3102 W END AVE
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-393-8800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5680 FRISCO SQUARE BLVD
Provider Second Line Business Practice Location Address:
SUITE 3000
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-535-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PICKLE
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP/TREASURER
Authorized Official Telephone Number:
615-393-8809

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3554974 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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