Provider Demographics
NPI:1962448308
Name:SAFE HAVEN ADULT DAY AND MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:SAFE HAVEN ADULT DAY AND MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ARNETTA
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-791-3288
Mailing Address - Street 1:12307 CHARLES LACEY DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-8837
Mailing Address - Country:US
Mailing Address - Phone:703-791-3288
Mailing Address - Fax:703-794-9987
Practice Address - Street 1:12307 CHARLES LACEY DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-8837
Practice Address - Country:US
Practice Address - Phone:703-791-3288
Practice Address - Fax:703-794-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052792208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09628Medicare ID - Type UnspecifiedGROUP NUMBER