Provider Demographics
NPI:1235406711
Name:SAFE HAVEN LENOX PARK
Entity Type:Organization
Organization Name:SAFE HAVEN LENOX PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARKADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-235-7733
Mailing Address - Street 1:1137 LYNMOOR DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4125
Mailing Address - Country:US
Mailing Address - Phone:404-235-7733
Mailing Address - Fax:404-235-4050
Practice Address - Street 1:1137 LYNMOOR DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-4125
Practice Address - Country:US
Practice Address - Phone:404-235-7733
Practice Address - Fax:404-235-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care