| Healing Haven Inc | |
|
1662 Highway 192 E London KY 40741-3114 | |
| (606) 389-5370 | |
| Not Available |
| Full Name | Healing Haven Inc |
|---|---|
| Speciality | Counselor |
| Location | 1662 Highway 192 E, London, Kentucky |
| Authorized Official Name and Position | Regina Lynn Lewis (DIRECTOR) |
| Authorized Official Contact | 6063125897 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Haven Inc 103 Sycamore St London KY 40741-1740 Ph: (606) 312-5897 | Healing Haven Inc 1662 Highway 192 E London KY 40741-3114 Ph: (606) 389-5370 |
| NPI Number | 1225755259 |
|---|---|
| Provider Enumeration Date | 10/20/2022 |
| Last Update Date | 02/28/2023 |
| Certification Date | 02/28/2023 |
| Medicare PECOS PAC ID | 9931571122 |
|---|---|
| Medicare Enrollment ID | O20230216002076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225755259 | NPI | - | NPPES |
| 7100869380 | Medicaid | KY | |
| 7100870220 | Medicaid | KY |
| Provider Name | Jerry Wayne Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720718620 PECOS PAC ID: 2365818804 Enrollment ID: I20221025000381 |
| Provider Name | Regina Lynn Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861742603 PECOS PAC ID: 1759753940 Enrollment ID: I20240120000158 |
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