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General NPI Number Information
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NPI Number | 1396970521
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Entity Type | Organization
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Legal Business Name | SAFE-HAVEN HOUSE II, LLC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 4202 OLD LIBERTY PLACE SAFE-HAVEN HOUSE II, LLC
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City | GREENSBORO
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State | NC
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Zip | 27406-7218
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Country | US
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Telephone | 336-685-4484
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Fax | 336-685-0144
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Provider Business Mailing Address
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Address Line | 4202 OLD LIBERTY PLACE SAFE-HAVEN HOUSE II, LLC
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City | GREENSBORO
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State | NC
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Zip | 27406-7218
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Country | US
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Telephone | 336-685-4484
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Fax | 336-685-0144
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SANDY WHITE
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Credential |
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Telephone | 336-685-4484
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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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