Healthcare Provider Details

I. General information

NPI: 1417873126
Provider Name (Legal Business Name): SAFE HAVEN COMMUNITY MENTAL HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LARCHMERE BLVD STE 310
CLEVELAND OH
44120-1103
US

IV. Provider business mailing address

12301 LARCHMERE BLVD STE 310
CLEVELAND OH
44120-1103
US

V. Phone/Fax

Practice location:
  • Phone: 216-374-7545
  • Fax:
Mailing address:
  • Phone: 216-374-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GANAWAY
Title or Position: OWNER
Credential:
Phone: 216-374-7545