Provider Demographics
NPI:1396970521
Name:SAFE-HAVEN HOUSE II, LLC
Entity type:Organization
Organization Name:SAFE-HAVEN HOUSE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-685-4484
Mailing Address - Street 1:4202 OLD LIBERTY PLACE
Mailing Address - Street 2:SAFE-HAVEN HOUSE II, LLC
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-7218
Mailing Address - Country:US
Mailing Address - Phone:336-685-4484
Mailing Address - Fax:336-685-0144
Practice Address - Street 1:4202 OLD LIBERTY PLACE
Practice Address - Street 2:SAFE-HAVEN HOUSE II, LLC
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-7218
Practice Address - Country:US
Practice Address - Phone:336-685-4484
Practice Address - Fax:336-685-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children