Organization
HAVEN RESIDENCES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FELIX KUHBILA MUTIA (CEO)
(757) 338-7411
Entity
Organization
Contact information
Practice address
3400 BANGOR CRES, CHESAPEAKE, VA 23321-4403
(757) 338-7412
Mailing address
104 HAWKS NEST LN, SUFFOLK, VA 23435-3272
(757) 338-7412
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4127
—
VA
Enumeration date
10/14/2022
Last updated
10/14/2022
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