Organization
HETTIE'S HAVEN,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI ANN TUCK (CONSULTANT)
(540) 586-4023
Entity
Organization
Contact information
Practice address
12108 RETFORD RD, COEBURN, VA 24230-5910
(276) 393-2530
Mailing address
12108 RETFORD RD, COEBURN, VA 24230-5910
(276) 393-2530
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2839-01-001
VA
Other
Enumeration date
08/07/2017
Last updated
07/21/2022
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