Provider Demographics
NPI:1578807400
Name:SAFE HARBOR HAVEN INC.
Entity Type:Organization
Organization Name:SAFE HARBOR HAVEN INC.
Other - Org Name:SAFE HARBOR BOYS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-757-7918
Mailing Address - Street 1:4772 SAFE HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-4024
Mailing Address - Country:US
Mailing Address - Phone:904-757-7918
Mailing Address - Fax:904-757-2504
Practice Address - Street 1:4772 SAFE HARBOR WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-4024
Practice Address - Country:US
Practice Address - Phone:904-757-7918
Practice Address - Fax:904-757-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty