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General NPI Number Information
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NPI Number | 1972478337
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN INTEGRATED LIVING LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1115 CLOVER ST
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City | SOUTH BEND
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State | IN
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Zip | 46615-1205
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Country | US
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Telephone | 317-759-4738
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 241074
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City | SPEEDWAY
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State | IN
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Zip | 46224-9274
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Country | US
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Telephone | 317-759-4738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS KATIA TRIONNE GAMMAGE
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Credential |
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Telephone | 317-759-4738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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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 | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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