Provider Demographics
NPI:1447412820
Name:SAFEHAVEN FAMILY SERVICE, LLC.
Entity type:Organization
Organization Name:SAFEHAVEN FAMILY SERVICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-230-1988
Mailing Address - Street 1:PO BOX 221872
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28222-1872
Mailing Address - Country:US
Mailing Address - Phone:980-230-1988
Mailing Address - Fax:
Practice Address - Street 1:410 SPRING STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5867
Practice Address - Country:US
Practice Address - Phone:980-230-1988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health