Provider Demographics
NPI:1568999506
Name:SAFE HAVEN YOUTH SERVICES
Entity Type:Organization
Organization Name:SAFE HAVEN YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:SUDC, NCAC II
Authorized Official - Phone:435-429-2683
Mailing Address - Street 1:964 S WHITE SANDS DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2023
Mailing Address - Country:US
Mailing Address - Phone:435-429-2683
Mailing Address - Fax:
Practice Address - Street 1:948 N 1300 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4965
Practice Address - Country:US
Practice Address - Phone:435-429-2683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT350887-6004OtherCMHC