Provider Demographics
NPI:1457683724
Name:SAFEHAVEN FAMILY SERVICE, LLC
Entity Type:Organization
Organization Name:SAFEHAVEN FAMILY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-400-1971
Mailing Address - Street 1:7950 NATIONS FORD RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-8020
Mailing Address - Country:US
Mailing Address - Phone:704-400-1971
Mailing Address - Fax:866-405-5481
Practice Address - Street 1:721 HYDRANGEA CIR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7258
Practice Address - Country:US
Practice Address - Phone:704-400-1971
Practice Address - Fax:866-405-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services