Organization
HAVEN SUPPORTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN HERMES (PRESIDENT CEO)
(620) 235-0177
Entity
Organization
Contact information
Practice address
920 E 8TH ST, PITTSBURG, KS 66762-4302
(620) 235-0177
(620) 235-0177
Mailing address
PO BOX 299, PITTSBURG, KS 66762-0299
(620) 235-0177
(620) 235-0177
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100401690A
—
KS
Enumeration date
02/13/2007
Last updated
06/18/2008
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