LAVERNE'S HAVEN RESIDENTIAL SERVICES (NPI# 1760875728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760875728 |
| Entity Type | Organization |
| Organization Name | LAVERNE'S HAVEN RESIDENTIAL SERVICES |
| Practice Address |
195 Brookside Dr Eden NC 27288-8123 |
| Mailing Address |
7022 Lakeview Ter Danville VA 24540-8248 |
| Practice Telephone | 3366273262 |
| Mailing Telephone | 4344892469 |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2015-03-13 |
| Authorized Official Name | MR. JEFFERY LYNN WOMACK (OWNER/OPERATOR) |
| Authorized Official Telephone | 4344892469 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
195 BROOKSIDE DR |
| City | EDEN |
| State | NC |
| Zip Code | 27288-8123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184179392 | Jeff Womack | Counselor | 195 Brookside Dr, Eden, NC 27288-8123 | 2016-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639781297 | Bailey Shea Scism | Pharmacist | 103 W Stadium Dr., Eden, NC 27288 | 2020-08-17 |
| 1538640628 | Donnell Corey Brown Jr. | Technician | 519 Orchard Drive, Eden, NC 27288 | 2018-08-27 |
| 1851728182 | Linda Mitchell | Physical Therapy Assistant | 114 E Kings Hwy, Eden, NC 27288 | 2013-10-01 |
| 1033341573 | Central State of The Carolinas, Inc. | Day Training, Developmentally Disabled Services | 229 Cedar St., Eden, NC 27288 | 2009-08-18 |
| 1114186483 | Enrich Cosmetic Center | Internal Medicine | 406 B Thompson St, Eden, NC 27288 | 2008-06-03 |
| 1265630891 | John R. Dabbs Jr. Dc PC | Preferred Provider Organization | 405 Boone Road, Eden, NC 27288 | 2007-07-05 |
| 1235283961 | James Harrison Eggleston | Dentist | 113 West Arbor Lane, Eden, NC 27288 | 2007-01-22 |
| 1962563940 | Barbara Collins Tanner | Nurse Practitioner | 134 North Pierce Street, Morehead High School Student Health Center, Eden, NC 27288 | 2006-12-13 |
| 1285690974 | Robert Maurice Vaughn | Chiropractor | 405 Boone Rd, Eden, NC 27288 | 2006-04-22 |
| 1619930666 | Direct Respiratory Services | Durable Medical Equipment & Medical Supplies | 302a North Pierce Street, Eden, NC 27288 | 2006-04-10 |
| Find all providers in zip 27288 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306384391 | Wescare Professional Services, LLC. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 115 Boyd St, Eden, NC 27288-4630 | 2017-02-09 |
| 1699100297 | Gail's Garden of Gold Corporation | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 904 Irving Ave, Eden, NC 27288-5510 | 2013-09-13 |
| 1144594409 | Vision of Hope | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 906 Sharpe Ave, Eden, NC 27288-3728 | 2012-03-05 |
| 1356597934 | Exceptional Care Professional Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 797 Red Clay Rd, Eden, NC 27288-2425 | 2008-08-14 |
| 1215545348 | Agape Home Living Care Phase II LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 315 Maple St, Eden, NC 27288-5513 | 2020-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578160552 | Residential Option Serving Adolescents, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2316 Carved Tree Ln, Charlotte, NC 28262-3154 | 2020-10-03 |
| 1649895442 | Gaynelle Bolling | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 102 Mandarin Dr, Pikeville, NC 27863-0020 | 2020-06-08 |
| 1851913966 | Johnson Enrichment Services LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 221 Foxcroft Dr, Winston Salem, NC 27103-5313 | 2020-05-12 |
| 1881230795 | Walter Jason Young Jr. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 412 Rook Rd, Charlotte, NC 28216-3199 | 2019-11-26 |
| 1750935839 | Heavenly Touch Residential Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4720 Baileys Lake Rd Nw Apt 204, Concord, NC 28027-8576 | 2019-07-28 |
| 1073166245 | Making Kids Matter, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 409 Hunton Forest Dr Nw, Concord, NC 28027-0186 | 2019-07-17 |
| 1891357752 | New Hope for Tomorrow LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 528 Baldwin Rd, Burlington, NC 27217-1702 | 2019-07-01 |
| 1114490877 | Brenda Gail Cannon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3105 Vico Ter, Raleigh, NC 27610-5951 | 2019-01-05 |
| 1356813455 | Lamesha Marshall | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3335 Avalon Ave, Charlotte, NC 28208-3378 | 2018-12-31 |
| 1487131074 | Ronald Anthony Benjamin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1594 Candace Ridge Dr, Greensboro, NC 27406-8595 | 2018-07-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.