MEDICARE: SAFE HAVEN DHC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1013584598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HAVEN DHC LLC

Provider Business Mailing Address
First Line	:	PO BOX 141
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48480-0141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3429 BARTH ST
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48504-2407
Country	:	US
Telephone Number	:	989-295-6980
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MATTIE PEARSON
Credential	:
Telephone Number	:	810-845-9170

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	06/04/2021

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