Provider Demographics
NPI:1912341629
Name:HAVEN BEHAVIORAL SERVICES OF PHILADELPHIA, LLC
Entity type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF PHILADELPHIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-0022
Mailing Address - Street 1:3102 W END AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1324
Mailing Address - Country:US
Mailing Address - Phone:615-393-8800
Mailing Address - Fax:615-982-8123
Practice Address - Street 1:3300 HENRY AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1121
Practice Address - Country:US
Practice Address - Phone:615-250-9500
Practice Address - Fax:615-250-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029437890001Medicaid