MEDICARE: ANN'S SAFE HAVEN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1538957972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN'S SAFE HAVEN LLC

Provider Business Mailing Address
First Line	:	400 N WASHINGTON ST STE E
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1716
Country	:	US
Telephone Number	:	573-315-6844
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N WASHINGTON ST STE E
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1716
Country	:	US
Telephone Number	:	573-330-5323
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. ALYSSA CRYSTAL FORD
Credential	:	MSW, LCSW
Telephone Number	:	573-330-5323

Provider Enumeration Date	:	04/26/2025
Last Update Date	:	05/08/2026

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Directions to “ANN'S SAFE HAVEN LLC ” Practice Location

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