Provider Demographics
NPI:1952682239
Name:CHANELL DANIELS DBA AARONS SAFE HAVEN
Entity Type:Organization
Organization Name:CHANELL DANIELS DBA AARONS SAFE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:EVERITT
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:SR
Authorized Official - Credentials:CEO
Authorized Official - Phone:210-399-1748
Mailing Address - Street 1:4035 NACO PERRIN BLVD STE 210A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2513
Mailing Address - Country:US
Mailing Address - Phone:210-399-1748
Mailing Address - Fax:210-384-2708
Practice Address - Street 1:4035 NACO PERRIN BLVD # 210A
Practice Address - Street 2:1012 HAYS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2513
Practice Address - Country:US
Practice Address - Phone:210-399-1748
Practice Address - Fax:210-384-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization