Provider Demographics
NPI:1679802920
Name:PRECIOUS HAVEN, INC.
Entity type:Organization
Organization Name:PRECIOUS HAVEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-868-6092
Mailing Address - Street 1:PO BOX 25821
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5013
Mailing Address - Country:US
Mailing Address - Phone:910-868-6092
Mailing Address - Fax:910-868-8882
Practice Address - Street 1:7762 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6246
Practice Address - Country:US
Practice Address - Phone:910-868-6092
Practice Address - Fax:910-868-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-673320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301769Medicaid