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
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
261QM3000X
Medically Fragile Infants and Children Day Care
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
12/20/2019
Last updated
01/04/2024
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