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General NPI Number Information
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NPI Number | 1003175936
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Entity Type | Organization
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Legal Business Name | A SAFE HAVEN ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 05/13/2012
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Last Update Date | 05/13/2012
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Provider Practice Location Address
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Address Line | 9000 86TH AVE
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City | SEMINOLE
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State | FL
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Zip | 33777-2641
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Country | US
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Telephone | 727-623-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 86TH AVE
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City | SEMINOLE
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State | FL
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Zip | 33777-2641
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Country | US
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Telephone | 727-623-9073
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARK T HUBA
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Credential |
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Telephone | 727-623-9073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12103
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License Number State | FL
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