Healthcare Provider Details

I. General information

NPI: 1457687519
Provider Name (Legal Business Name): SAFE HAVEN SKILLED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W MAIN ST BOX 755
NEW BLOOMFIELD PA
17068-9603
US

IV. Provider business mailing address

1566 NEW BLOOMFIELD RD
NEW BLOOMFIELD PA
17068-8036
US

V. Phone/Fax

Practice location:
  • Phone: 717-582-4110
  • Fax: 717-582-4138
Mailing address:
  • Phone: 717-582-9977
  • Fax: 717-582-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number03600501
License Number StatePA

VIII. Authorized Official

Name: MRS. SANDRA LEE HARDY
Title or Position: AGENCY DIRECTOR
Credential: CSA, BS
Phone: 717-582-4110