1225873615 NPI number — HAVEN ROOM THERAPY SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225873615 NPI number — HAVEN ROOM THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN ROOM THERAPY SERVICES, LLC
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:
Provider Other Organization Name Type Code:
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:
1225873615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28210 PASEO DRIVE, SUITE 190
Provider Second Line Business Mailing Address:
OFFICE 232
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33543-3753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
147-776-4626
Provider Business Mailing Address Fax Number:
813-336-8404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28210 PASEO DRIVE, SUITE 190
Provider Second Line Business Practice Location Address:
OFFICE 232
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33543-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
147-776-4626
Provider Business Practice Location Address Fax Number:
813-336-8404
Provider Enumeration Date:
06/27/2024

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCIS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
HOPSON
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
813-776-4626

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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