Healthcare Provider Details

I. General information

NPI: 1104753979
Provider Name (Legal Business Name): SAFE HAVEN HOMECARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SYCAMORE ST UNIT 901
CINCINNATI OH
45202-2261
US

IV. Provider business mailing address

716 SYCAMORE ST UNIT 901
CINCINNATI OH
45202-2261
US

V. Phone/Fax

Practice location:
  • Phone: 463-245-8726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JENO PIERRE SHANKLIN JR.
Title or Position: OWNER
Credential:
Phone: 463-245-8726