Provider Demographics
NPI:1194931360
Name:CLIFF HAVEN ADULT DAY HEALTH CARE INC
Entity type:Organization
Organization Name:CLIFF HAVEN ADULT DAY HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA,PHD
Authorized Official - Phone:817-795-8066
Mailing Address - Street 1:2117 ROOSEVELT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5936
Mailing Address - Country:US
Mailing Address - Phone:817-795-8066
Mailing Address - Fax:682-651-4532
Practice Address - Street 1:2117 ROOSEVELT DR
Practice Address - Street 2:SUITE B
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-5936
Practice Address - Country:US
Practice Address - Phone:817-795-8066
Practice Address - Fax:682-651-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
TX118770385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000303600Medicaid