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General NPI Number Information
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NPI Number | 1568949329
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Entity Type | Organization
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Legal Business Name | A SAFE HAVEN, L.L.C.
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 2750 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60608-1094
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Country | US
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Telephone | 312-372-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 15507 CICERO AVE STE 200
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City | OAK FOREST
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State | IL
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Zip | 60452-3633
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Country | US
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Telephone | 773-435-8429
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | MS. MELANIE DZADO
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Credential |
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Telephone | 312-372-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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