Provider Demographics
NPI:1558242594
Name:GENTLE HAVEN HOME INC
Entity type:Organization
Organization Name:GENTLE HAVEN HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-750-2888
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-1011
Mailing Address - Country:US
Mailing Address - Phone:256-750-2888
Mailing Address - Fax:
Practice Address - Street 1:1133 LAMONT CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8704
Practice Address - Country:US
Practice Address - Phone:256-750-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty