Provider Demographics
NPI:1942097910
Name:DIVERSITY HAVEN LLC
Entity type:Organization
Organization Name:DIVERSITY HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-689-7032
Mailing Address - Street 1:304 NUGGET CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6832
Mailing Address - Country:US
Mailing Address - Phone:910-689-7032
Mailing Address - Fax:
Practice Address - Street 1:304 NUGGET CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6832
Practice Address - Country:US
Practice Address - Phone:910-689-7032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health