Provider Demographics
NPI:1902080260
Name:HAVEN HEALTH CLINICS
Entity Type:Organization
Organization Name:HAVEN HEALTH CLINICS
Other - Org Name:TEXAS PANHANDLE FAMILY PLANNING & HEALTH CENTERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COGDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-1565
Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4137
Mailing Address - Country:US
Mailing Address - Phone:806-322-3599
Mailing Address - Fax:806-372-5237
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4137
Practice Address - Country:US
Practice Address - Phone:806-322-3599
Practice Address - Fax:806-372-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1076010Medicaid