Organization
LAVERNE'S HAVEN RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY LYNN WOMACK (OWNER/OPERATOR)
(434) 489-2469
Entity
Organization
Contact information
Practice address
195 BROOKSIDE DR, EDEN, NC 27288-8123
(336) 627-3262
Mailing address
7022 LAKEVIEW TER, DANVILLE, VA 24540-8248
(434) 489-2469
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/13/2015
Last updated
03/13/2015
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