Provider Demographics
NPI:1629241088
Name:SAFEHAVEN FAMILY SERVICE, LLC.
Entity Type:Organization
Organization Name:SAFEHAVEN 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:MARIE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-400-1971
Mailing Address - Street 1:109 CORBAN AVE SW
Mailing Address - Street 2:106
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5129
Mailing Address - Country:US
Mailing Address - Phone:704-262-2295
Mailing Address - Fax:704-262-2294
Practice Address - Street 1:109 CORBAN AVE SW
Practice Address - Street 2:106
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5129
Practice Address - Country:US
Practice Address - Phone:704-262-2295
Practice Address - Fax:704-262-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency