Provider Demographics
NPI:1083460208
Name:SAFE HAVEN AUTISM CENTER LLLC
Entity type:Organization
Organization Name:SAFE HAVEN AUTISM CENTER LLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:KHALIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-428-3783
Mailing Address - Street 1:9000 CITY PLACE BLVD UNIT 2506
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-5519
Mailing Address - Country:US
Mailing Address - Phone:651-428-3783
Mailing Address - Fax:
Practice Address - Street 1:9000 CITY PLACE BLVD UNIT 2506
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-5519
Practice Address - Country:US
Practice Address - Phone:651-428-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities