Provider Demographics
NPI:1295881910
Name:HAVEN OF POSITIVE ENRICHMENT, INC.
Entity type:Organization
Organization Name:HAVEN OF POSITIVE ENRICHMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-827-2777
Mailing Address - Street 1:P.O. BOX 101
Mailing Address - Street 2:
Mailing Address - City:PINETOPS
Mailing Address - State:NC
Mailing Address - Zip Code:27864-0101
Mailing Address - Country:US
Mailing Address - Phone:252-827-2777
Mailing Address - Fax:252-827-2770
Practice Address - Street 1:103 SW FIRST STREET
Practice Address - Street 2:
Practice Address - City:PINETOPS
Practice Address - State:NC
Practice Address - Zip Code:27886-0101
Practice Address - Country:US
Practice Address - Phone:252-827-2777
Practice Address - Fax:827-827-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017R5OtherBLUE CROSS BLUE SHIELD NC
NC6005764Medicaid
NC8301988Medicaid