Provider Demographics
NPI:1104447770
Name:HAVEN COMMUNITY AND SOCIAL SERVICES AGENCY
Entity type:Organization
Organization Name:HAVEN COMMUNITY AND SOCIAL SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-350-4697
Mailing Address - Street 1:43284 W ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-8236
Mailing Address - Country:US
Mailing Address - Phone:520-350-4697
Mailing Address - Fax:
Practice Address - Street 1:43284 W ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-8236
Practice Address - Country:US
Practice Address - Phone:520-350-4697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAY STARZ GROUP HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ265556Medicaid