Provider Demographics
NPI:1346505450
Name:SAFE HAVEN CARE AND FAMILY SERVICES
Entity Type:Organization
Organization Name:SAFE HAVEN CARE AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:469-275-2274
Mailing Address - Street 1:PO BOX 793522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-3522
Mailing Address - Country:US
Mailing Address - Phone:469-275-2274
Mailing Address - Fax:
Practice Address - Street 1:2401 STOCKBRIDGE RD
Practice Address - Street 2:12108
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6187
Practice Address - Country:US
Practice Address - Phone:469-275-2274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty