Provider Demographics
NPI:1063749075
Name:SAFE HAVEN CHILDRENS SERVICES, LLC
Entity type:Organization
Organization Name:SAFE HAVEN CHILDRENS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-413-0842
Mailing Address - Street 1:503 BOWMAN GRAY DR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7286
Mailing Address - Country:US
Mailing Address - Phone:252-413-0842
Mailing Address - Fax:252-413-0749
Practice Address - Street 1:503 BOWMAN GRAY DR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7286
Practice Address - Country:US
Practice Address - Phone:252-413-0842
Practice Address - Fax:252-413-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC209253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency