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Organization
PEDIATRIC HAVEN
Active
Organization
PEDIATRIC HAVEN
Active
Other names
Pediatric Haven Autism Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JETUWAN M. BROWN RN (MANAGING PARTNER)
(601) 622-2997
Entity
Organization
Contact information
Practice address
102 LEXINGTON DR, MADISON, MS 39110-6952
(601) 499-6696
(601) 499-6696
Mailing address
103 HONOURS DR, MADISON, MS 39110-6513
(601) 622-2997
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
NULL
103K00000X
Behavior Analyst
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
NULL
261QM3000X
Medically Fragile Infants and Children Day Care
—
NULL
3140N1450X
Pediatric Skilled Nursing Facility
—
NULL
385HR2055X
Child Mental Illness Respite Care
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
NULL
385HR2065X
Child Physical Disabilities Respite Care
—
NULL
Other
Enumeration date
12/20/2019
Last updated
01/04/2024
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