Provider Demographics
NPI:1518248830
Name:SAFEHAVE FAMILY SERVICE, LLC
Entity Type:Organization
Organization Name:SAFEHAVE 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:
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:28217-8014
Mailing Address - Country:US
Mailing Address - Phone:704-400-1971
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4432253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care