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General NPI Number Information
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NPI Number | 1346505450
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN CARE AND FAMILY SERVICES
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 2401 STOCKBRIDGE RD 12108
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City | DENTON
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State | TX
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Zip | 76208-6187
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Country | US
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Telephone | 469-275-2274
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 793522
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City | DALLAS
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State | TX
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Zip | 75379-3522
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Country | US
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Telephone | 469-275-2274
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS JAMILA MONIQUE GILLIAM
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Credential | LBSW
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Telephone | 469-275-2274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 56214
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License Number State | TX
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