Healthcare Provider Details

I. General information

NPI: 1982304697
Provider Name (Legal Business Name): A SAFE HAVEN YOUTH & FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 S VAL VISTA DR # 119
MESA AZ
85204-6401
US

IV. Provider business mailing address

1237 S VAL VISTA DR # 119
MESA AZ
85204-6401
US

V. Phone/Fax

Practice location:
  • Phone: 480-452-8763
  • Fax:
Mailing address:
  • Phone: 480-452-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. JAZMARIE MADER
Title or Position: CEO
Credential:
Phone: 480-452-8763