Provider Demographics
NPI:1659599611
Name:A NEW SAFEHAVEN
Entity Type:Organization
Organization Name:A NEW SAFEHAVEN
Other - Org Name:SOUTHWEST WASHINGTON SAFEHAVEN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSERD-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-577-4340
Mailing Address - Street 1:1441 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3818
Mailing Address - Country:US
Mailing Address - Phone:360-577-4340
Mailing Address - Fax:360-577-4350
Practice Address - Street 1:1441 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3818
Practice Address - Country:US
Practice Address - Phone:360-577-4340
Practice Address - Fax:360-577-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6440SWOtherREGENCE IDENTIFICATION
WA145054826OtherDUN #
WA602-308-263OtherUBI NUMBER