Provider Demographics
NPI:1720559420
Name:SECURE HAVEN CARE, LLC
Entity Type:Organization
Organization Name:SECURE HAVEN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAKOVLIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-348-6016
Mailing Address - Street 1:4295 BRAUNTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4301
Mailing Address - Country:US
Mailing Address - Phone:740-348-6016
Mailing Address - Fax:
Practice Address - Street 1:4295 BRAUNTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-4301
Practice Address - Country:US
Practice Address - Phone:740-348-6016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities