Provider Demographics
NPI:1194940957
Name:SAFE HAVEN HOUSE LLC
Entity type:Organization
Organization Name:SAFE HAVEN HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:STALEY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-685-4484
Mailing Address - Street 1:4250 OLD JULIAN RD
Mailing Address - Street 2:PO BOX 323
Mailing Address - City:JULIAN
Mailing Address - State:NC
Mailing Address - Zip Code:27283-9217
Mailing Address - Country:US
Mailing Address - Phone:336-685-4484
Mailing Address - Fax:336-685-0144
Practice Address - Street 1:4250 OLD JULIAN RD
Practice Address - Street 2:BOX 323
Practice Address - City:JULIAN
Practice Address - State:NC
Practice Address - Zip Code:27283-9217
Practice Address - Country:US
Practice Address - Phone:336-685-4484
Practice Address - Fax:336-685-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-810322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children