Provider Demographics
NPI:1043909211
Name:SAFE HAVEN RESIDENTIAL CARE
Entity Type:Organization
Organization Name:SAFE HAVEN RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:757-362-2165
Mailing Address - Street 1:6 MAUPIN CT
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-1024
Mailing Address - Country:US
Mailing Address - Phone:757-362-2165
Mailing Address - Fax:
Practice Address - Street 1:6 MAUPIN CT
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-1024
Practice Address - Country:US
Practice Address - Phone:757-362-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO22294Medicaid