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General NPI Number Information
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NPI Number | 1124850243
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Entity Type | Organization
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Legal Business Name | SAFE HEAVEN HOMES LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 216 HAWES AVE
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City | SHOREVIEW
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State | MN
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Zip | 55126-6232
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Country | US
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Telephone | 651-529-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 200 WINTHROP ST S APT 234
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City | SAINT PAUL
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State | MN
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Zip | 55119-5039
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Country | US
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Telephone | 651-529-5117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. NERVILLE NKIPANG RIH-REH SR.
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Credential | SOCIAL WORKER
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Telephone | 651-529-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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