MEDICARE: SAFE HAVEN INTEGRATED LIVING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TR0400X	Rehabilitation Psychologist
3	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist
4	225XP0019X	Physical Rehabilitation Occupational Therapist
5	3747P1801X	Personal Care Attendant
6	376J00000X	Homemaker
7	405300000X	Prevention Professional
8	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1972478337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HAVEN INTEGRATED LIVING LLC

Provider Business Mailing Address
First Line	:	PO BOX 241074
Second Line	:
City	:	SPEEDWAY
State	:	IN
Zip	:	46224-9274
Country	:	US
Telephone Number	:	317-759-4738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 CLOVER ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-1205
Country	:	US
Telephone Number	:	317-759-4738
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS KATIA TRIONNE GAMMAGE
Credential	:
Telephone Number	:	317-759-4738

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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