Provider Demographics
NPI:1902619604
Name:HAVEN'S HOLISTIC HEALING LLC
Entity type:Organization
Organization Name:HAVEN'S HOLISTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHASTIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:812-322-4979
Mailing Address - Street 1:3100 S WALNUT STREET PIKE APT B158
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-7369
Mailing Address - Country:US
Mailing Address - Phone:812-322-4979
Mailing Address - Fax:
Practice Address - Street 1:3100 S WALNUT STREET PIKE APT B158
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7369
Practice Address - Country:US
Practice Address - Phone:812-322-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care