Healthcare Provider Details

I. General information

NPI: 1730326703
Provider Name (Legal Business Name): SAFE HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6721 GILLS GATE CT
CHESTERFIELD VA
23832-6005
US

IV. Provider business mailing address

6432 ELKHARDT RD
RICHMOND VA
23225-7819
US

V. Phone/Fax

Practice location:
  • Phone: 804-674-5394
  • Fax: 804-745-7554
Mailing address:
  • Phone: 804-745-8070
  • Fax: 804-745-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number57414001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number57414001
License Number StateVA

VIII. Authorized Official

Name: DR. GRACE ILORI
Title or Position: DIRECTOR
Credential: PH.D
Phone: 804-745-8070