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General NPI Number Information
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NPI Number | 1043008329
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN HOME
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1677 MAIN STREET
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City | FAYETTE
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State | MS
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Zip | 39069
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Country | US
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Telephone | 601-341-3916
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 GREAT POINT RD
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City | MCCOMB
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State | MS
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Zip | 39648-4753
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Country | US
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Telephone | 601-341-3916
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS LATOYA RENEE CAMERON
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Credential | NP
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Telephone | 601-341-3916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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