Provider Demographics
NPI:1023553401
Name:SAFE HAVEN BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SAFE HAVEN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YINKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERIKI
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:602-687-0557
Mailing Address - Street 1:2235 W PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-7299
Mailing Address - Country:US
Mailing Address - Phone:602-687-0557
Mailing Address - Fax:602-566-7624
Practice Address - Street 1:2128 W BURGESS LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5306
Practice Address - Country:US
Practice Address - Phone:602-687-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5045106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty