Provider Demographics
NPI:1679905269
Name:REST HAVEN LLC
Entity type:Organization
Organization Name:REST HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:STERLING
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:757-572-7206
Mailing Address - Street 1:1005 BLAND STREET
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513
Mailing Address - Country:US
Mailing Address - Phone:757-351-6981
Mailing Address - Fax:
Practice Address - Street 1:1005 BLAND ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-3386
Practice Address - Country:US
Practice Address - Phone:757-351-6981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness