Provider Demographics
NPI:1619511615
Name:CHILDREN'S SAFE HAVEN INC
Entity Type:Organization
Organization Name:CHILDREN'S SAFE HAVEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONESHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-822-3178
Mailing Address - Street 1:1939 GOLDSMITH LANE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3175
Mailing Address - Country:US
Mailing Address - Phone:502-822-3178
Mailing Address - Fax:502-822-3179
Practice Address - Street 1:1939 GOLDSMITH LANE
Practice Address - Street 2:SUITE 130
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3175
Practice Address - Country:US
Practice Address - Phone:502-822-3178
Practice Address - Fax:502-822-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100638520Medicaid