| Haven's Holistic Healing LLC | |
|
901 S Rogers St Ste 101 Bloomington IN 47403-4760 | |
| (812) 322-4979 | |
| (317) 669-6896 |
| Full Name | Haven's Holistic Healing LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 901 S Rogers St Ste 101, Bloomington, Indiana |
| Authorized Official Name and Position | Chastidy Haven (OWNER) |
| Authorized Official Contact | 8123224979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Haven's Holistic Healing LLC 901 S Rogers St Ste 101 Bloomington IN 47403-4760 Ph: (812) 322-4979 | Haven's Holistic Healing LLC 901 S Rogers St Ste 101 Bloomington IN 47403-4760 Ph: (812) 322-4979 |
| NPI Number | 1902619604 |
|---|---|
| Provider Enumeration Date | 01/28/2025 |
| Last Update Date | 04/07/2026 |
| Certification Date | 04/07/2026 |
| Medicare PECOS PAC ID | 2062933526 |
|---|---|
| Medicare Enrollment ID | O20250313000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902619604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Lydia Ruth Banton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831353911 PECOS PAC ID: 8729423843 Enrollment ID: I20240228004136 |
| Provider Name | Chastidy Mader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407694375 PECOS PAC ID: 0547709057 Enrollment ID: I20241010002181 |
| Provider Name | Kylie Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366337750 PECOS PAC ID: 7113439670 Enrollment ID: I20250621000278 |
| Provider Name | Amanda Jane Brashear |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174317259 PECOS PAC ID: 6901391945 Enrollment ID: I20251217003972 |
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