Healthcare Provider Details

I. General information

NPI: 1235406711
Provider Name (Legal Business Name): SAFE HAVEN LENOX PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 LYNMOOR DR NE
ATLANTA GA
30319-4125
US

IV. Provider business mailing address

1137 LYNMOOR DR NE
ATLANTA GA
30319-4125
US

V. Phone/Fax

Practice location:
  • Phone: 404-235-7733
  • Fax: 404-235-4050
Mailing address:
  • Phone: 404-235-7733
  • Fax: 404-235-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ARKADIY YAKUBOV
Title or Position: DIRECTOR
Credential:
Phone: 404-235-7733