Provider Demographics
NPI:1841978293
Name:MEME'S SAFE HAVEN YOUTH RESOURCE CENTER
Entity type:Organization
Organization Name:MEME'S SAFE HAVEN YOUTH RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN/FACILITATOR/COACH
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:BEHAVIORAL HEALTH
Authorized Official - Phone:310-779-8804
Mailing Address - Street 1:1453 W DYSART ROAD SUITE 106
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-0110
Mailing Address - Country:US
Mailing Address - Phone:310-779-8804
Mailing Address - Fax:
Practice Address - Street 1:10763 W MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1155
Practice Address - Country:US
Practice Address - Phone:310-779-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty