# PEDIATRIC HAVEN

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric Haven Autism Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043858053
- **Authorized official:** MRS. JETUWAN M. BROWN RN (MANAGING PARTNER)
- **Authorized official phone:** (601) 622-2997

## Contact information

- **Practice address:** 102 LEXINGTON DR, MADISON, MS 39110-6952
- **Practice address phone:** (601) 499-6696
- **Practice address fax:** (601) 499-6696
- **Mailing address:** 103 HONOURS DR, MADISON, MS 39110-6513
- **Mailing address phone:** (601) 622-2997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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