Provider Demographics
NPI:1588099527
Name:TIMOTHY'S HAVENS LLC
Entity type:Organization
Organization Name:TIMOTHY'S HAVENS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:FRANCENA
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:BLS
Authorized Official - Phone:757-497-0925
Mailing Address - Street 1:154 NEWTOWN RD
Mailing Address - Street 2:SUITE B2-100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2406
Mailing Address - Country:US
Mailing Address - Phone:757-497-0925
Mailing Address - Fax:757-497-0953
Practice Address - Street 1:154 NEWTOWN RD
Practice Address - Street 2:SUITE B2-100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2406
Practice Address - Country:US
Practice Address - Phone:757-497-0925
Practice Address - Fax:757-497-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health