Provider Demographics
NPI:1417517723
Name:SAFE HAVEN SUPPORT SERVICES
Entity Type:Organization
Organization Name:SAFE HAVEN SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCHANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:813-475-8151
Mailing Address - Street 1:9305 W RIVERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-5626
Mailing Address - Country:US
Mailing Address - Phone:813-475-8151
Mailing Address - Fax:
Practice Address - Street 1:9305 W RIVERCHASE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-5626
Practice Address - Country:US
Practice Address - Phone:813-475-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management