Healthcare Provider Details

I. General information

NPI: 1619549755
Provider Name (Legal Business Name): SAFE HAVEN BEHAVIORAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6187 NW 167TH ST STE H26
MIAMI GARDENS FL
33015-4366
US

IV. Provider business mailing address

7382 NW 35TH TER UNIT 106
MIAMI FL
33122-1241
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-5666
  • Fax: 305-402-6101
Mailing address:
  • Phone: 305-705-5666
  • Fax: 305-402-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS LEDESMA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 305-335-9627