Healthcare Provider Details

I. General information

NPI: 1982131132
Provider Name (Legal Business Name): SAFE HAVEN ADULT FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 NW 8TH ST
LAUDERHILL FL
33311-6513
US

IV. Provider business mailing address

3410 NW 8TH ST
LAUDERHILL FL
33311-6513
US

V. Phone/Fax

Practice location:
  • Phone: 954-865-3382
  • Fax:
Mailing address:
  • Phone: 954-865-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906824
License Number StateFL

VIII. Authorized Official

Name: MS. VILMA MCKAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-534-1066