Healthcare Provider Details

I. General information

NPI: 1124206800
Provider Name (Legal Business Name): A SAFE HAVEN, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 W ROOSEVELT RD
CHICAGO IL
60608
US

IV. Provider business mailing address

15507 CICERO AVE STE 200
OAK FOREST IL
60452-3633
US

V. Phone/Fax

Practice location:
  • Phone: 773-435-8429
  • Fax: 773-435-8482
Mailing address:
  • Phone: 312-372-6707
  • Fax: 312-372-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA-0274-0016-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA-0274-0016-A
License Number StateIL

VIII. Authorized Official

Name: MR. BRIAN M ROWLAND
Title or Position: CEO
Credential:
Phone: 312-372-6707