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General NPI Number Information
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NPI Number | 1891266557
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Entity Type | Organization
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Legal Business Name | NICKELI'S SAFE HAVEN INC
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 9057 S PARNELL AVE
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City | CHICAGO
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State | IL
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Zip | 60620-2240
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Country | US
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Telephone | 773-960-3024
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Fax |
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Provider Business Mailing Address
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Address Line | 9057 S PARNELL AVE
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City | CHICAGO
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State | IL
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Zip | 60620-2240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDYN GARNER
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Credential | LPN
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Telephone | 773-960-3024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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