Healthcare Provider Details

I. General information

NPI: 1407426000
Provider Name (Legal Business Name): ALL TOGETHER SAFE HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4813 S LINDER AVE
CHICAGO IL
60638-1707
US

IV. Provider business mailing address

4813 S LINDER AVE
CHICAGO IL
60638-1707
US

V. Phone/Fax

Practice location:
  • Phone: 773-837-4884
  • Fax:
Mailing address:
  • Phone: 773-837-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: FREDRICKA SIMS
Title or Position: OWNER/CEO
Credential:
Phone: 708-578-3920