Provider Demographics
NPI:1982492401
Name:MARILYNS SAFE HAVEN
Entity type:Organization
Organization Name:MARILYNS SAFE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKOSUA
Authorized Official - Middle Name:AGYEIBEA
Authorized Official - Last Name:NYAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-268-7405
Mailing Address - Street 1:1007 PITMAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9846
Mailing Address - Country:US
Mailing Address - Phone:336-268-7405
Mailing Address - Fax:
Practice Address - Street 1:4605 MEADOWCROFT RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-8083
Practice Address - Country:US
Practice Address - Phone:336-268-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities