Organization
FULL LIFE HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY MERE MPA (PRINCIPAL)
(301) 379-5088
Entity
Organization
Contact information
Practice address
11731 GLEN MILL RD, POTOMAC, MD 20854-1916
(301) 379-5088
Mailing address
11731 GLEN MILL RD, POTOMAC, MD 20854-1916
(301) 379-5088
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/09/2022
Last updated
08/09/2022
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