Provider Demographics
NPI:1447984075
Name:HAVEN AT BLUE CREEK LLC
Entity type:Organization
Organization Name:HAVEN AT BLUE CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BALOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-342-8362
Mailing Address - Street 1:1290 E ARLINGTON BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7854
Mailing Address - Country:US
Mailing Address - Phone:877-342-8362
Mailing Address - Fax:
Practice Address - Street 1:2582 BLUE CREEK LN
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-9641
Practice Address - Country:US
Practice Address - Phone:877-342-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility