| Haven House | |
|
1411 Union Blvd Allentown PA 18109 | |
| (610) 433-6181 | |
| (610) 433-5124 |
| Full Name | Haven House |
|---|---|
| Speciality | Clinic/Center |
| Location | 1411 Union Blvd, Allentown, Pennsylvania |
| Authorized Official Name and Position | Amanda M Dunsing (FISCAL MANAGER) |
| Authorized Official Contact | 6104336181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Haven House 1411 Union Blvd Allentown PA 18109-2423 Ph: (610) 433-6181 | Haven House 1411 Union Blvd Allentown PA 18109 Ph: (610) 433-6181 |
| NPI Number | 1689670507 |
|---|---|
| Provider Enumeration Date | 06/24/2005 |
| Last Update Date | 01/13/2022 |
| Certification Date | 01/13/2022 |
| Medicare PECOS PAC ID | 3476536780 |
|---|---|
| Medicare Enrollment ID | O20040609000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689670507 | NPI | - | NPPES |
| 1007763130006 | Medicaid | PA | |
| 260526000 | Other | PA | MCO PROVIDER NUMBER |
| 1007763130009 | Medicaid | PA | |
| 1007763130007 | Medicaid | PA | |
| 1007763130005 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 211340 (Pennsylvania) | Primary |
| Provider Name | Alex T Thomas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336171008 PECOS PAC ID: 6608776901 Enrollment ID: I20040112000431 |
| Provider Name | Kimberly Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245441765 PECOS PAC ID: 6305920554 Enrollment ID: I20080226000691 |
| Provider Name | Enrique M Lirag |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932200219 PECOS PAC ID: 1557447745 Enrollment ID: I20080328000152 |
| Provider Name | Donald E Graham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063634251 PECOS PAC ID: 5991024564 Enrollment ID: I20150501001859 |
| Provider Name | Laura Troxel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346892882 PECOS PAC ID: 7214265800 Enrollment ID: I20190820003754 |
| Provider Name | Brittany Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982075016 PECOS PAC ID: 0941688154 Enrollment ID: I20220531001973 |
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