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General NPI Number Information
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NPI Number | 1942054804
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Entity Type | Organization
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Legal Business Name | FAMILY MATTERS SAFE HAVEN
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 1435 DIPLOMAT DR
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City | RIVERDALE
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State | GA
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Zip | 30296-2030
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Country | US
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Telephone | 678-790-2754
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Fax |
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Provider Business Mailing Address
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Address Line | 7845 COLLINSWOOD CT
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City | JONESBORO
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State | GA
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Zip | 30236-3399
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Country | US
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Telephone | 678-790-2754
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CASSANDRA MOTEN
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Credential |
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Telephone | 678-790-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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