Provider Demographics
NPI:1619208709
Name:SAFE HAVEN HEALTH CARE LLC
Entity Type:Organization
Organization Name:SAFE HAVEN HEALTH CARE LLC
Other - Org Name:SAFE HAVEN HOSPITAL OF POCATELLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-539-0751
Mailing Address - Street 1:2520 SOUTH 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204
Mailing Address - Country:US
Mailing Address - Phone:800-261-2443
Mailing Address - Fax:888-222-6504
Practice Address - Street 1:1200 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2708
Practice Address - Country:US
Practice Address - Phone:208-233-2570
Practice Address - Fax:888-815-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1619208709Medicaid
ID134016Medicare Oscar/Certification