=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033064266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL SAFE HAVEN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2026
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 957 MAIN ST STE 131
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-597-2390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 957 MAIN ST STE 131
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-597-2390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | GWENDOLYN RENEE SHUMATE-WILLIAMS
-----------------------------------------------------
Credential | SHUMATE-WILLIAMS
-----------------------------------------------------
Telephone | 404-597-2390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------