Healthcare Provider Details

I. General information

NPI: 1245536093
Provider Name (Legal Business Name): SAFEHAVEN FAMILY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 NATIONS FORD RD SUITE C1
CHARLOTTE NC
28217-8014
US

IV. Provider business mailing address

721 HYDRANGEA CIR NW
CONCORD NC
28027-7258
US

V. Phone/Fax

Practice location:
  • Phone: 704-400-1971
  • Fax: 866-405-5481
Mailing address:
  • Phone: 704-400-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VERONICA CLARK-GEORGE
Title or Position: CEO
Credential:
Phone: 704-400-1971