Provider Demographics
NPI:1285140483
Name:SAFE HARBOR TREATMENT CENTER FOR WOMEN INC
Entity type:Organization
Organization Name:SAFE HARBOR TREATMENT CENTER FOR WOMEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VELVET
Authorized Official - Middle Name:BLEAU
Authorized Official - Last Name:MANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-645-1026
Mailing Address - Street 1:1966 MAPLE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2660
Mailing Address - Country:US
Mailing Address - Phone:714-849-9434
Mailing Address - Fax:714-242-6775
Practice Address - Street 1:546 BERNARD ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2658
Practice Address - Country:US
Practice Address - Phone:949-645-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300221AP324500000X
CA300221DP324500000X
CA300221CP3245S0500X
CA300221BP3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children