Provider Demographics
NPI:1053342220
Name:HAVENWYCK HOSPITAL INC
Entity type:Organization
Organization Name:HAVENWYCK HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SRVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:1525 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2673
Mailing Address - Country:US
Mailing Address - Phone:248-373-9200
Mailing Address - Fax:248-373-4113
Practice Address - Street 1:1525 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2673
Practice Address - Country:US
Practice Address - Phone:248-373-9200
Practice Address - Fax:248-373-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH-075/2006283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI170528921Medicaid
MI00106OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI234023Medicare Oscar/Certification