Healthcare Provider Details

I. General information

NPI: 1043147242
Provider Name (Legal Business Name): A SAFE HAVEN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N BROAD ST E STE 201
ANGIER NC
27501-5638
US

IV. Provider business mailing address

8 N BROAD ST E STE 201
ANGIER NC
27501-5638
US

V. Phone/Fax

Practice location:
  • Phone: 919-400-7863
  • Fax: 919-460-1895
Mailing address:
  • Phone: 919-375-8392
  • Fax: 919-460-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TREVOR A ULRICH
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 919-375-8392