Organization
HAVEN HEALTH CARE MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NOVA C CRAWFORD (PRESIDENT)
(573) 722-9191
Entity
Organization
Contact information
Practice address
502 W STURDIVANT ST, ADVANCE, MO 63730-7261
(573) 722-9191
(573) 722-9393
Mailing address
502 W STURDIVANT ST, PO BOX 137, ADVANCE, MO 63730-7261
(573) 722-9191
(573) 722-9393
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
268934
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
597241306
—
MO
Enumeration date
03/05/2007
Last updated
08/10/2012
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