Provider Demographics
NPI:1922520048
Name:HAVEN IN THE CITY LLC
Entity type:Organization
Organization Name:HAVEN IN THE CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OVERBY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:612-329-0047
Mailing Address - Street 1:7600 143RD STREET WEST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:APPLE CALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:612-546-1951
Mailing Address - Fax:
Practice Address - Street 1:7600 143RD STREET WEST
Practice Address - Street 2:SUITE 100
Practice Address - City:APPLE CALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:612-546-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1774171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1295108819Medicaid