Provider Demographics
NPI:1467862219
Name:JIMERSON SAFE HAVEN
Entity Type:Organization
Organization Name:JIMERSON SAFE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JANITA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-434-0085
Mailing Address - Street 1:135 SWEETBRIAR CIRCLE
Mailing Address - Street 2:POBOX 204
Mailing Address - City:MOORESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28114
Mailing Address - Country:US
Mailing Address - Phone:704-434-0085
Mailing Address - Fax:704-434-0085
Practice Address - Street 1:135 SWEETBRIAR CIRCLE
Practice Address - Street 2:
Practice Address - City:MOOREBORO
Practice Address - State:NC
Practice Address - Zip Code:28114
Practice Address - Country:US
Practice Address - Phone:704-434-0085
Practice Address - Fax:704-434-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency