Organization
HAVEN POINTE L3C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANYA L FORD (CEO/OWNER)
(773) 559-6764
Entity
Organization
Contact information
Practice address
4056 W 115TH ST APT 100, CHICAGO, IL 60655-4333
(773) 559-6764
Mailing address
4056 W 115TH ST APT 100, CHICAGO, IL 60655-4333
(773) 559-6764
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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