Provider Demographics
NPI:1770199689
Name:A SAFE HAVEN, L.L.C.
Entity Type:Organization
Organization Name:A SAFE HAVEN, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DZADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-372-6707
Mailing Address - Street 1:15507 CICERO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3633
Mailing Address - Country:US
Mailing Address - Phone:312-372-6707
Mailing Address - Fax:
Practice Address - Street 1:1930 S WABASH AVE STE C1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4651
Practice Address - Country:US
Practice Address - Phone:312-372-6707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL17002OtherDHS COMMUNITY MENTAL HEALTH CERTIFICATION