MEDICARE: SAFE HAVEN GROUP 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1609628544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HAVEN GROUP LLC

Provider Business Mailing Address
First Line	:	459 DOUGLAS AVE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1061
Country	:	US
Telephone Number	:	515-745-8587
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 DOUGLAS AVE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1061
Country	:	US
Telephone Number	:	515-745-8587
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LOUISA IRANKUNDA
Credential	:
Telephone Number	:	515-587-7572

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/15/2025

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Directions to “SAFE HAVEN GROUP LLC ” Practice Location

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