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General NPI Number Information
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NPI Number | 1992265060
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Entity Type | Organization
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Legal Business Name | SAFE HAVEN GROUP HOME, LLC
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Dates
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Enumeration Date | 03/23/2019
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Last Update Date | 03/23/2019
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Provider Practice Location Address
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Address Line | 5903 N NORFOLK AVE
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City | TULSA
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State | OK
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Zip | 74126-2323
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Country | US
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Telephone | 918-779-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 5903 N NORFOLK AVE
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City | TULSA
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State | OK
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Zip | 74126-2323
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Country | US
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Telephone | 918-779-4263
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. THEDA NIGEL GRIFFIN
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Credential |
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Telephone | 720-585-8021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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