Provider Demographics
NPI:1750823399
Name:SAFE HAVEN TRANSITIONAL YOUTH SERVICES
Entity Type:Organization
Organization Name:SAFE HAVEN TRANSITIONAL YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:KATANGA
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-433-8780
Mailing Address - Street 1:3021 MACALLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7269
Mailing Address - Country:US
Mailing Address - Phone:804-795-5976
Mailing Address - Fax:
Practice Address - Street 1:3021 MACALLAN PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-7269
Practice Address - Country:US
Practice Address - Phone:804-795-5976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACRF474323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility