Organization
HENDERSON HAVEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE HENDERSON (PRES CEO)
(904) 264-2522
Entity
Organization
Contact information
Practice address
2554 MOODY AVE, ORANGE PARK, FL 32073-5937
(904) 264-2522
(904) 215-7338
Mailing address
2554 MOODY AVE, ORANGE PARK, FL 32073-5937
(904) 264-2522
(904) 215-7338
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
F001
FL
251V00000X
Voluntary or Charitable Agency
CH17033
FL
305S00000X
Point of Service
F001
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
683650096
—
FL
05
—
683650098
—
FL
Enumeration date
04/19/2006
Last updated
07/21/2022
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