Provider Demographics
NPI:1932848843
Name:HAVEN FOCUSED VETERANS SERVICES
Entity type:Organization
Organization Name:HAVEN FOCUSED VETERANS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-414-4126
Mailing Address - Street 1:8902 OTIS AVE STE 105B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-1076
Mailing Address - Country:US
Mailing Address - Phone:317-414-4126
Mailing Address - Fax:317-723-3615
Practice Address - Street 1:8902 OTIS AVE STE 105B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1076
Practice Address - Country:US
Practice Address - Phone:317-414-4126
Practice Address - Fax:317-723-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1437896966Medicaid