Healthcare Provider Details

I. General information

NPI: 1235069667
Provider Name (Legal Business Name): SAFEHAVEN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 CHAIN BRIDGE RD STE 103
FAIRFAX VA
22030-4105
US

IV. Provider business mailing address

4101 CHAIN BRIDGE RD STE 103
FAIRFAX VA
22030-4105
US

V. Phone/Fax

Practice location:
  • Phone: 603-341-8081
  • Fax: 703-263-8148
Mailing address:
  • Phone: 603-341-8081
  • Fax: 703-263-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SURAJ SANGROULA
Title or Position: MANAGER
Credential:
Phone: 603-341-8081