Provider Demographics
NPI:1104000272
Name:SAFE HAVEN CARE, LLC
Entity Type:Organization
Organization Name:SAFE HAVEN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMMING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BANKS
Authorized Official - Last Name:KENERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-774-2943
Mailing Address - Street 1:PO BOX 8304
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-1304
Mailing Address - Country:US
Mailing Address - Phone:225-683-1230
Mailing Address - Fax:225-683-9691
Practice Address - Street 1:9613 PLANK ROAD
Practice Address - Street 2:SUITE O
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-683-1230
Practice Address - Fax:225-683-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20031311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home