Healthcare Provider Details

I. General information

NPI: 1801348362
Provider Name (Legal Business Name): JONES SAFE HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 LAWRY AVE
N LAS VEGAS NV
89032-3527
US

IV. Provider business mailing address

2017 LAWRY AVE
N LAS VEGAS NV
89032-3527
US

V. Phone/Fax

Practice location:
  • Phone: 310-461-5576
  • Fax:
Mailing address:
  • Phone: 310-461-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KAMYLAH MIMS
Title or Position: MANAGER
Credential:
Phone: 310-461-5576