Provider Demographics
NPI:1376699819
Name:ABUNDANCE SAFE HAVEN INC
Entity Type:Organization
Organization Name:ABUNDANCE SAFE HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRON
Authorized Official - Middle Name:HORATIOUS
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-680-2030
Mailing Address - Street 1:1821 HILLANDALE RD
Mailing Address - Street 2:1B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 FISKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-1615
Practice Address - Country:US
Practice Address - Phone:919-680-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-322320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness