1831522762 NPI number — SAFE HAVEN HEALTH CARE LLC

Table of content: (NPI 1831522762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831522762 NPI number — SAFE HAVEN HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFE HAVEN HEALTH CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELL MOUNTAIN VILLAGE AND CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831522762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 S 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83204-1923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-261-2443
Provider Business Mailing Address Fax Number:
888-222-6504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAILEY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83333-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-578-3504
Provider Business Practice Location Address Fax Number:
208-788-7210
Provider Enumeration Date:
08/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
208-221-9137

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  H6 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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