Provider Demographics
NPI:1992265060
Name:SAFE HAVEN GROUP HOME, LLC
Entity type:Organization
Organization Name:SAFE HAVEN GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THEDA
Authorized Official - Middle Name:NIGEL
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-585-8021
Mailing Address - Street 1:5903 N NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126-2323
Mailing Address - Country:US
Mailing Address - Phone:918-779-4263
Mailing Address - Fax:
Practice Address - Street 1:5903 N NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74126-2323
Practice Address - Country:US
Practice Address - Phone:918-779-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management