Provider Demographics
NPI:1801304365
Name:SAFE HAVEN ASSISTED LIVING
Entity type:Organization
Organization Name:SAFE HAVEN ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-215-9375
Mailing Address - Street 1:12480 TOPAZ CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3539
Mailing Address - Country:US
Mailing Address - Phone:240-300-3209
Mailing Address - Fax:
Practice Address - Street 1:6310 JOSEPHINE RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3207
Practice Address - Country:US
Practice Address - Phone:202-215-9375
Practice Address - Fax:202-215-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility