Healthcare Provider Details

I. General information

NPI: 1285176446
Provider Name (Legal Business Name): SAFE HAVEN RESIDENTIAL LIVING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E NORTH MAIN ST
RICHMOND MO
64085-1916
US

IV. Provider business mailing address

810 E NORTH MAIN ST
RICHMOND MO
64085-1916
US

V. Phone/Fax

Practice location:
  • Phone: 816-615-3230
  • Fax:
Mailing address:
  • Phone: 816-615-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-615-3230