Provider Demographics
NPI:1891037883
Name:BLUE HAVEN CONSULTATION SERVICE INC.
Entity type:Organization
Organization Name:BLUE HAVEN CONSULTATION SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-415-3832
Mailing Address - Street 1:20417 HILLSIDE AVE
Mailing Address - Street 2:SUITE #309
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2213
Mailing Address - Country:US
Mailing Address - Phone:718-415-3832
Mailing Address - Fax:
Practice Address - Street 1:20417 HILLSIDE AVE
Practice Address - Street 2:SUITE #309
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2213
Practice Address - Country:US
Practice Address - Phone:718-415-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management