Healthcare Provider Details

I. General information

NPI: 1134585433
Provider Name (Legal Business Name): SAFE HAVEN RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NW 165TH ST STE 310
MIAMI FL
33169-6304
US

IV. Provider business mailing address

540 NW 165TH ST STE 310
MIAMI FL
33169-6304
US

V. Phone/Fax

Practice location:
  • Phone: 305-956-7823
  • Fax: 305-956-7825
Mailing address:
  • Phone: 305-956-7823
  • Fax: 305-956-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1113AD526501
License Number StateFL

VIII. Authorized Official

Name: KELI KORNMILLER
Title or Position: SENIOR CREDENTIALING SPECIALIST
Credential:
Phone: 561-672-8345