Provider Demographics
NPI:1982304697
Name:A SAFE HAVEN YOUTH & FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:A SAFE HAVEN YOUTH & FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-499-3991
Mailing Address - Street 1:2266 S DOBSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6412
Mailing Address - Country:US
Mailing Address - Phone:480-499-3991
Mailing Address - Fax:
Practice Address - Street 1:2266 S DOBSON RD STE 200
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6412
Practice Address - Country:US
Practice Address - Phone:480-499-3991
Practice Address - Fax:480-691-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ832044Medicaid