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General NPI Number Information
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NPI Number | 1144756685
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN SENIOR CARE
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 414 E 19TH ST
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City | MARSHFIELD
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State | WI
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Zip | 54449-5074
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Country | US
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Telephone | 715-898-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 414 E 19TH ST
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City | MARSHFIELD
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State | WI
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Zip | 54449-5074
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Country | US
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Telephone | 715-898-1731
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHANNON SCHNITZLER
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Credential | RN
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Telephone | 715-207-3395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 0016433
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License Number State | WI
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