Healthcare Provider Details

I. General information

NPI: 1417130683
Provider Name (Legal Business Name): SAFE HAVEN OUTREACH MINISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N CAPITOL ST NW APT 924
WASHINGTON DC
20002-7579
US

IV. Provider business mailing address

1140 N CAPITOL ST NW APT 924
WASHINGTON DC
20002-7579
US

V. Phone/Fax

Practice location:
  • Phone: 202-589-1505
  • Fax: 202-589-1534
Mailing address:
  • Phone: 202-589-1505
  • Fax: 202-589-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. EUGENA E BEARD
Title or Position: EXECUTIVE DIRECTOR
Credential: CACII, MHS
Phone: 202-589-1505