Healthcare Provider Details

I. General information

NPI: 1033064266
Provider Name (Legal Business Name): SAFE HAVEN CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 MAIN ST STE 131
STONE MOUNTAIN GA
30083-3060
US

IV. Provider business mailing address

5722 GREENRIDGE CT
LITHONIA GA
30058-2202
US

V. Phone/Fax

Practice location:
  • Phone: 404-597-2390
  • Fax:
Mailing address:
  • Phone: 404-597-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN RENEE SHUMATE-WILLIAMS
Title or Position: MEMBER
Credential: SHUMATE-WILLIAMS
Phone: 404-597-2390