Provider Demographics
NPI:1225412604
Name:SAFE HAVEN ASSISTED LIVING FACILITY, INC
Entity Type:Organization
Organization Name:SAFE HAVEN ASSISTED LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-460-3529
Mailing Address - Street 1:2505 E ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-4460
Mailing Address - Country:US
Mailing Address - Phone:352-460-3529
Mailing Address - Fax:352-748-1600
Practice Address - Street 1:2505 EAST ORANGE AVE.
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:34785
Practice Address - Country:US
Practice Address - Phone:352-460-3529
Practice Address - Fax:352-748-1600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE HAVEN ASSISTED LIVING FACILITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care