Provider Demographics
NPI:1821265414
Name:SAFE HAVEN OF PENDER, INC.
Entity Type:Organization
Organization Name:SAFE HAVEN OF PENDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-259-8989
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-0657
Mailing Address - Country:US
Mailing Address - Phone:910-259-8989
Mailing Address - Fax:
Practice Address - Street 1:1411 US HIGHWAY 117 S
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-7756
Practice Address - Country:US
Practice Address - Phone:910-259-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health