Healthcare Provider Details

I. General information

NPI: 1124850243
Provider Name (Legal Business Name): SAFE HEAVEN HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HAWES AVE
SHOREVIEW MN
55126-6232
US

IV. Provider business mailing address

200 WINTHROP ST S APT 234
SAINT PAUL MN
55119-5039
US

V. Phone/Fax

Practice location:
  • Phone: 651-529-5117
  • Fax:
Mailing address:
  • Phone: 651-529-5117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. NERVILLE NKIPANG RIH-REH SR.
Title or Position: OWNER
Credential: SOCIAL WORKER
Phone: 651-529-5117