Healthcare Provider Details

I. General information

NPI: 1548402126
Provider Name (Legal Business Name): SAFEHAUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21056 DEAN ST
WARREN MI
48091-2760
US

IV. Provider business mailing address

21056 DEAN ST
WARREN MI
48091-2760
US

V. Phone/Fax

Practice location:
  • Phone: 586-806-4678
  • Fax: 313-454-8447
Mailing address:
  • Phone: 586-806-4678
  • Fax: 313-454-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberCM500297574
License Number StateMI

VIII. Authorized Official

Name: DR. ROMAN JOHN KOLODCHIN
Title or Position: CEO
Credential: PHD
Phone: 586-806-4678