=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326459959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVE HAVEN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2014
-----------------------------------------------------
Last Update Date | 05/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 SW 12TH AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33444-1534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-777-0241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7952
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33482-7952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-777-0241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | GREGORY DURAND GOYINS
-----------------------------------------------------
Credential | MBR
-----------------------------------------------------
Telephone | 561-777-0241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------