1922052752 NPI number — HAVEN HEALTH CLINICS

Table of content: (NPI 1922052752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922052752 NPI number — HAVEN HEALTH CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN HEALTH CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEXAS PANHANDLE FAMILY PLANNING AND HEALTH CENTERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922052752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-322-3599
Provider Business Mailing Address Fax Number:
806-372-5237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-322-3599
Provider Business Practice Location Address Fax Number:
806-372-5237
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COGDILL
Authorized Official First Name:
CAROLENA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
806-242-1565

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP2300X , with the licence number: 564160 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1076010 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".