Provider Demographics
NPI:1295453702
Name:SAFE HAVEN SENIOR TRANSPORT LLC
Entity type:Organization
Organization Name:SAFE HAVEN SENIOR TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-358-7206
Mailing Address - Street 1:2770 BARDIN RD APT 5304
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7300
Mailing Address - Country:US
Mailing Address - Phone:214-970-8794
Mailing Address - Fax:
Practice Address - Street 1:1341 W MOCKINGBIRD LN
Practice Address - Street 2:SUITE 600W-#30
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:972-358-7206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle