Healthcare Provider Details

I. General information

NPI: 1922557685
Provider Name (Legal Business Name): SAFE HAVEN RECOVERY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CENTERPOINT DR STE 302
MIDDLETOWN CT
06457-7570
US

IV. Provider business mailing address

515 CENTERPOINT DR STE 302
MIDDLETOWN CT
06457-7570
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-4552
  • Fax: 203-693-4552
Mailing address:
  • Phone: 877-407-4552
  • Fax: 203-693-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. EMMANUELLA MARIE VALME
Title or Position: PRESIDENT/CEO
Credential:
Phone: 877-407-0353