Provider Demographics
NPI:1649950007
Name:A SAFE HAVEN RESIDENTIAL SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:A SAFE HAVEN RESIDENTIAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-748-8570
Mailing Address - Street 1:2117 SMITH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2519
Mailing Address - Country:US
Mailing Address - Phone:757-580-1525
Mailing Address - Fax:757-257-0351
Practice Address - Street 1:2117 SMITH AVE STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2519
Practice Address - Country:US
Practice Address - Phone:757-580-1525
Practice Address - Fax:757-257-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services