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General NPI Number Information
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NPI Number | 1245780964
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Entity Type | Organization
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Legal Business Name | ANGELS' SAFE HAVEN, LLC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 2571 N. 149TH AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395
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Country | US
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Telephone | 623-440-4086
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Fax | 623-440-5939
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Provider Business Mailing Address
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Address Line | P.O. BOX 7206
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City | SURPRISE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-210-6382
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Fax | 623-440-5939
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Authorized Official
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Title or Position | CEO
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Name | MR. RICHARD EDWARD HORNE
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Credential |
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Telephone | 623-210-6382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment 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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | BH5019
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License Number State | AZ
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