Provider Demographics
NPI:1043008329
Name:SAFE HAVEN HOME
Entity type:Organization
Organization Name:SAFE HAVEN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-341-3916
Mailing Address - Street 1:1080 GREAT POINT RD
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4753
Mailing Address - Country:US
Mailing Address - Phone:601-341-3916
Mailing Address - Fax:
Practice Address - Street 1:1677 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069
Practice Address - Country:US
Practice Address - Phone:601-341-3916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities