Healthcare Provider Details

I. General information

NPI: 1629645288
Provider Name (Legal Business Name): SAFE HAVEN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CONTINENTAL PL STE 120
BRENTWOOD TN
37027-1086
US

IV. Provider business mailing address

1309 CONCORD MILL LN
NASHVILLE TN
37211-8632
US

V. Phone/Fax

Practice location:
  • Phone: 404-435-9441
  • Fax:
Mailing address:
  • Phone: 404-435-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SHAWN KONATA GREEN
Title or Position: CO OWNER
Credential: DNP
Phone: 404-435-9441